1083831499 NPI number — INFINITY EMPOWERMENT SERVICES

Table of content: (NPI 1083831499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083831499 NPI number — INFINITY EMPOWERMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFINITY EMPOWERMENT SERVICES
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:
1083831499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 E PEARL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08016-1705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-747-9391
Provider Business Mailing Address Fax Number:
609-747-9968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
HADDON TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08108-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-346-2409
Provider Business Practice Location Address Fax Number:
609-747-9968
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILEY
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
609-346-2409

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC05263500 , 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: 0065161 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com