1457369357 NPI number — STEPHEN G VARHOL MD

Table of content: STEPHEN G VARHOL MD (NPI 1457369357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457369357 NPI number — STEPHEN G VARHOL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARHOL
Provider First Name:
STEPHEN
Provider Middle Name:
G
Provider Name Prefix Text:
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:
VARHOL
Provider Other First Name:
S
Provider Other Middle Name:
GREGORY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457369357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 OLD TAPPAN ROAD
Provider Second Line Business Mailing Address:
OLD TAPPAN MEDICAL GROUP
Provider Business Mailing Address City Name:
OLD TAPPAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-666-1000
Provider Business Mailing Address Fax Number:
201-666-7610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 OLD TAPPAN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLD TAPPAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-666-1000
Provider Business Practice Location Address Fax Number:
201-666-7610
Provider Enumeration Date:
08/04/2006

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: 207R00000X , with the licence number:  MA02920800 , 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: 010029208NJ01 . This is a "ANTHEM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1491826 . This is a "UNITEDHLTHCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4749308 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80603 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 998608 . This is a "REFERRAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23811 . This is a "MASTERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: BP035 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: F01393 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 973431 . This is a "EMPIRE HLTHCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13348 . This is a "USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 221941517002 . This is a "PRUDENTIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4218300 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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