1972531457 NPI number — DR. WILLIAM RICHARD CHENITZ MD, FACP

Table of content: DR. WILLIAM RICHARD CHENITZ MD, FACP (NPI 1972531457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972531457 NPI number — DR. WILLIAM RICHARD CHENITZ MD, FACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHENITZ
Provider First Name:
WILLIAM
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, FACP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHENITZ
Provider Other First Name:
WILLIAM
Provider Other Middle Name:
RICHARD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, FACP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1972531457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-624-4908
Provider Business Mailing Address Fax Number:
973-877-5595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07102-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-624-4908
Provider Business Practice Location Address Fax Number:
973-877-5595
Provider Enumeration Date:
06/30/2006

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: 207RN0300X , with the licence number:  MA021777 , 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: 1161709 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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