1558507780 NPI number — JOHN POJEDINEC M.D., P.A.

Table of content: (NPI 1558507780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558507780 NPI number — JOHN POJEDINEC M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN POJEDINEC M.D., P.A.
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:
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:
1558507780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 PROSPECT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HACKENSACK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07601-1960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-343-1900
Provider Business Mailing Address Fax Number:
201-343-0520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 PROSPECT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-1960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-343-1900
Provider Business Practice Location Address Fax Number:
201-343-0520
Provider Enumeration Date:
12/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
POJEDINEC
Authorized Official First Name:
JANINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
201-343-1900

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  25MA03381800 , 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: 14A091 . This is a "WELLCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4093286 . This is a "AETNA (CARECORE NATIONAL)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 85257 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: DO2728 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 142622 . This is a "UNITED HC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 108972600 . This is a "UNITED STATES DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1424602 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5359837006 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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