1477549657 NPI number — CORNELL HEALTHCARE CORP

Table of content: (NPI 1477549657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477549657 NPI number — CORNELL HEALTHCARE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNELL HEALTHCARE 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:
MR MOBILITY
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:
1477549657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
368 LINCOLN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLESEX
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08846-2372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-247-6666
Provider Business Mailing Address Fax Number:
732-247-6664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
368 LINCOLN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLESEX
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08846-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-247-6666
Provider Business Practice Location Address Fax Number:
732-247-6664
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BATISTA
Authorized Official First Name:
CRISTINA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-247-6666

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 205566 . This is a "HIMARK BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6910301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30005813 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9016267 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003099688 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0114834 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0015782100003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1152976 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1538865 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 175614 . This is a "ELDER PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4542042 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01650655 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: A2521948 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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