1457377996 NPI number — ELIAS A. LIANOS

Table of content: ELIAS A. LIANOS (NPI 1457377996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457377996 NPI number — ELIAS A. LIANOS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIANOS
Provider First Name:
ELIAS
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1457377996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 W GILBERT ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
TINTON FALLS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07701-4947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-212-0051
Provider Business Mailing Address Fax Number:
732-212-0713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 PATERSON ST
Provider Second Line Business Practice Location Address:
SUITE 5100B
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901-1962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-235-6512
Provider Business Practice Location Address Fax Number:
732-235-6124
Provider Enumeration Date:
07/15/2006

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: 207RN0300X , with the licence number:  MA68588 , 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: 7998902 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".