1669463402 NPI number — FAIRFIELD TOWNSHIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669463402 NPI number — FAIRFIELD TOWNSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRFIELD TOWNSHIP
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:
FAIRFIELD TWP AMB SRVC
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:
1669463402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 66
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08320-0066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-473-2278
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-451-3676
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BATEMAN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
856-451-3676

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0X00200379 . This is a "ACS HEALTH NET COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5113903 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1079100 . This is a "KEYSTONE MERCY HMO DPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0X00200379 . This is a "PHS HEALTHPLAN COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91000397400 . This is a "AMERICHOICE OF NJ INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91000397400 . This is a "AMERICAN CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0120129 . This is a "AETNA USHC BLUE BELL HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0X00200379 . This is a "ACS HEALTH NET HMO MDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0X00200379 . This is a "PHS HEALTH PLAN HMO MDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0X00200379 . This is a "QUALMED" identifier . This identifiers is of the category "OTHER".




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