1083251375 NPI number — JOSHUA PERSAUD MD LLC

Table of content: THERESA SMALL CNM, APRN (NPI 1033684659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083251375 NPI number — JOSHUA PERSAUD MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSHUA PERSAUD MD LLC
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:
1083251375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59 NORTHWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN LAKES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07417-2292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
516-517-9515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 WASHINGTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEEHAWKEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-794-6008
Provider Business Practice Location Address Fax Number:
516-517-9515
Provider Enumeration Date:
12/05/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PERSAUD
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
561-389-0118

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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