1831198399 NPI number — ELMWOOD EVESHAM ASSOCIATES, LLC

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 1831198399 NPI number — ELMWOOD EVESHAM ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELMWOOD EVESHAM 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:
CARE ONE AT EVESHAM
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:
1831198399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
870 EAST ROUTE 70
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-396-0005
Provider Business Mailing Address Fax Number:
856-396-0004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
870 EAST ROUTE 70
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-396-0005
Provider Business Practice Location Address Fax Number:
856-396-0004
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LUGO
Authorized Official First Name:
A.
Authorized Official Middle Name:
ALBERTO
Authorized Official Title or Position:
EXECUTIVE VP & GENERAL COUNSEL
Authorized Official Telephone Number:
201-242-4000

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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: 8299901 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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