1114996477 NPI number — ANTHONY J BARRAVECCHIO D.O.

Table of content: ANTHONY J BARRAVECCHIO D.O. (NPI 1114996477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114996477 NPI number — ANTHONY J BARRAVECCHIO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRAVECCHIO
Provider First Name:
ANTHONY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1114996477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 HAMBURG TPKE
Provider Second Line Business Mailing Address:
WAYNE COMMONS, SUITE 101
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07470-2025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-942-6005
Provider Business Mailing Address Fax Number:
973-942-6009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 HAMBURG TPKE
Provider Second Line Business Practice Location Address:
WAYNE COMMONS, SUITE 101
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-942-6005
Provider Business Practice Location Address Fax Number:
973-942-6009
Provider Enumeration Date:
03/17/2006

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: 207R00000X , with the licence number:  25MB06978600 , 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: 7678228 . This is a "AETNA PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1K8291 . This is a "HEALTHNET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6R2921 . This is a "EMPIRE BC/BS #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 080180176 . This is a "RAILROAD MDCR #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2016613000 . This is a "AMERIHEALTH ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2586866 . This is a "AETNA HMO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8643903 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5716972 . This is a "GHI PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2010902 . This is a "OXFORD ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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