1942215306 NPI number — DR. CLIFFORD W TOLIVER M.D.

Table of content: DR. CLIFFORD W TOLIVER M.D. (NPI 1942215306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942215306 NPI number — DR. CLIFFORD W TOLIVER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOLIVER
Provider First Name:
CLIFFORD
Provider Middle Name:
W
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:
1942215306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 CENTRAL AVE
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
EAST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07018-2835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-676-6207
Provider Business Mailing Address Fax Number:
973-676-3974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 CENTRAL AVE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
EAST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07018-2835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-676-6207
Provider Business Practice Location Address Fax Number:
973-676-3974
Provider Enumeration Date:
07/31/2006

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: 207VG0400X , with the licence number:  MA33187 , 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: F13666 . This is a "HEATH NET OF NE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: GHI . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5Y3431 . This is a "EMPIRE BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3076202 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P430048 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0494696 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1035108 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7958501 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16560 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1601581 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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