1114145935 NPI number — CENTRAL JERSEY ENDOCRINE ASSOC LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114145935 NPI number — CENTRAL JERSEY ENDOCRINE ASSOC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL JERSEY ENDOCRINE ASSOC 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:
RICHARD J AGRIN,MD, LEON SHULMAN,MD
Provider Other Organization Name Type Code:
3
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:
1114145935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 US HIGHWAY 202/206 STE 1B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEWATER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08807-1746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-385-1946
Provider Business Mailing Address Fax Number:
908-231-1324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 US HIGHWAY 202/206 STE 1B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEWATER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08807-1746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-385-1946
Provider Business Practice Location Address Fax Number:
908-231-1321
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHULMAN
Authorized Official First Name:
LEON
Authorized Official Middle Name:
H
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
908-231-1311

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  55313,56079,33417 , 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: 529320 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8695105 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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