1457346918 NPI number — DR. ALFONSO CIERVO MD

Table of content: DR. ALFONSO CIERVO MD (NPI 1457346918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457346918 NPI number — DR. ALFONSO CIERVO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIERVO
Provider First Name:
ALFONSO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1457346918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 CRAPE MYRTLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLMDEL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07733-1529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-380-1222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 HIGHWAY 35
Provider Second Line Business Practice Location Address:
SUITE 106A
Provider Business Practice Location Address City Name:
EATONTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07724-3427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-380-1222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA06756800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0035378 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2K7795 . This is a "HEALTHNET ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5337R1 . This is a "BCBS OF NY ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2313631000 . This is a "AMERIHEALTH ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7790588 . This is a "AETNA PPO ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8221858 . This is a "GHI PPO ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3732796 . This is a "AETNA HMO ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 97662 . This is a "AMERICAID / AMERIGROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00158098 . This is a "RAILROAD MEDICARE ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".