1699707422 NPI number — GARY H BELT MD

Table of content: GARY H BELT MD (NPI 1699707422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699707422 NPI number — GARY H BELT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELT
Provider First Name:
GARY
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1699707422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 416457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-6457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-971-4179
Provider Business Mailing Address Fax Number:
973-971-7905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 BEAUVOIR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMIT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07901-3533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-522-6142
Provider Business Practice Location Address Fax Number:
908-522-6147
Provider Enumeration Date:
07/06/2006

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: 2084N0400X , with the licence number:  48160 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 303370 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: E-11832 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 24303 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 53475 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 028205 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0P0199 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010028205CT01 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 790191 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001282052 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".