1043228588 NPI number — IRFAN ADMANI

Table of content: IRFAN ADMANI (NPI 1043228588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043228588 NPI number — IRFAN ADMANI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADMANI
Provider First Name:
IRFAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1043228588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 RIVER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGEWATER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-941-8100
Provider Business Mailing Address Fax Number:
201-941-2899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 RIVER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWATER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-941-8100
Provider Business Practice Location Address Fax Number:
201-941-2899
Provider Enumeration Date:
08/03/2006

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: 207RC0000X , with the licence number:  25MA07010400 , 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: 3K4611 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 02810057 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2771801000 . This is a "AMERIHEALTH#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7616451 . This is a "AETNA PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 719P01 . This is a "EMPIRE BCBS EDGEWATER#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 789P01 . This is a "EMPIRE BCBS# SECAUCUS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00336977 . This is a "RAILROAD MEDICARE ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1369767 . This is a "AETNA HMO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8440905 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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