1467582643 NPI number — DR. JUDITH B PRICE D.O.

Table of content: DR. JUDITH B PRICE D.O. (NPI 1467582643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467582643 NPI number — DR. JUDITH B PRICE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
JUDITH
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1467582643
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:
19 LENAPE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BASKING RIDGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07920-2677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-464-3636
Provider Business Mailing Address Fax Number:
908-464-6711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 LYONS MALL
Provider Second Line Business Practice Location Address:
PMB 342
Provider Business Practice Location Address City Name:
BASKING RIDGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07920-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-464-3636
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2007

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: 208100000X , with the licence number:  25MB05044500 , 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: 6035906 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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