1790997088 NPI number — DR. ROGER T BARR EDD

Table of content: DR. ROGER T BARR EDD (NPI 1790997088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790997088 NPI number — DR. ROGER T BARR EDD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARR
Provider First Name:
ROGER
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
EDD
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:
1790997088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 DANIELS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOOLWICH TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-467-1125
Provider Business Mailing Address Fax Number:
856-467-6884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
488 N GLASSBORO ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURY HEIGHTS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-848-3279
Provider Business Practice Location Address Fax Number:
856-467-6884
Provider Enumeration Date:
05/07/2007

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: 103TC0700X , with the licence number:  355100097000 , 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)