1790817633 NPI number — ACCESS MEDICAL ASSOCIATES LLC

Table of content: (NPI 1790817633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790817633 NPI number — ACCESS MEDICAL ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS MEDICAL ASSOCIATES LLC
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:
1790817633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3322 ROUTE 22
Provider Second Line Business Mailing Address:
BUILDING #1
Provider Business Mailing Address City Name:
BRANCHBURG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08876-3476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-704-0100
Provider Business Mailing Address Fax Number:
908-704-0090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3322 US HIGHWAY 22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANCHBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08876-3476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-704-0100
Provider Business Practice Location Address Fax Number:
908-704-0090
Provider Enumeration Date:
03/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOLDBERG
Authorized Official First Name:
LON
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
908-704-0100

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  25MB04654000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 25MB04654000 , 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)