1386953362 NPI number — PRIORITY ONE CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386953362 NPI number — PRIORITY ONE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY ONE CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORECARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386953362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 LAKEHURST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08755-8044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-505-4007
Provider Business Mailing Address Fax Number:
732-736-8811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
551 LAKEHURST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08755-8044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-505-4007
Provider Business Practice Location Address Fax Number:
732-736-8811
Provider Enumeration Date:
09/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
OSCAR
Authorized Official Middle Name:
TANYAG
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-581-3566

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)