1114978939 NPI number — PARTNERS IN FREEDOM 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 1114978939 NPI number — PARTNERS IN FREEDOM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTNERS IN FREEDOM 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:
1114978939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3350 HWY 138 STE 217
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALL TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07719-9694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-974-1980
Provider Business Mailing Address Fax Number:
732-681-0835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3350 HWY 138 STE 217
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALL TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07719-9694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-974-1980
Provider Business Practice Location Address Fax Number:
732-681-0835
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SICILIANO
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICIAL DELEGATE/PRESIDENT
Authorized Official Telephone Number:
732-974-1980

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , 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: 5599107 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60004140 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2296455001 . This is a "AMERIHEALTH SEA GIRT LOCA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0034835 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2296455002 . This is a "AMERIHEALTH HOWELL LOCATI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: DB7403 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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