1881689495 NPI number — DR. STEVE LEQUERICA MD

Table of content: DR. STEVE LEQUERICA MD (NPI 1881689495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881689495 NPI number — DR. STEVE LEQUERICA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEQUERICA
Provider First Name:
STEVE
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1881689495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 ALLWOOD RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
CLIFTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07012-1945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-471-3680
Provider Business Mailing Address Fax Number:
973-471-6360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 ALLWOOD RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
CLIFTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07012-1945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-471-3680
Provider Business Practice Location Address Fax Number:
973-471-6360
Provider Enumeration Date:
09/20/2005

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:  25MA04606800 , 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: 0100004850 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0357901 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4516374 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: OK1390 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 130005561 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10780 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1340273 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: PS225 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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