1013673805 NPI number — SUGARRX INC

Table of content: ZELDA A. DEMMEL LCSW (NPI 1932197829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013673805 NPI number — SUGARRX INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUGARRX INC
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:
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:
1013673805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4207 BERGENLINE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-867-6705
Provider Business Mailing Address Fax Number:
201-867-3758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4207 BERGENLINE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-867-6705
Provider Business Practice Location Address Fax Number:
201-867-3758
Provider Enumeration Date:
11/16/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BERNAT
Authorized Official First Name:
GABRIELA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-867-6705

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3914550001 . This is a "MEDICARE NSC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2056801 . This is a "PK" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0828572 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".