1891785945 NPI number — DR. GODFREY PINDER M.D.

Table of content: DR. GODFREY PINDER M.D. (NPI 1891785945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891785945 NPI number — DR. GODFREY PINDER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINDER
Provider First Name:
GODFREY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1891785945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 OLD INDIAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07052-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-731-7441
Provider Business Mailing Address Fax Number:
973-731-8381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 KIEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINNELON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07405-2565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-731-7441
Provider Business Practice Location Address Fax Number:
973-731-8381
Provider Enumeration Date:
10/28/2005

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: 208G00000X , with the licence number:  25MA03268300 , 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: 1543648 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2899701 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00681576 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000051800 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0K2003 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: DO0974 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3849007 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0529470 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 466196M . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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