1124335047 NPI number — CYPRESS HEALTH INSTITUTE OF NEW JERSEY

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 1124335047 NPI number — CYPRESS HEALTH INSTITUTE OF NEW JERSEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYPRESS HEALTH INSTITUTE OF NEW JERSEY
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:
1124335047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 599
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTCLAIR
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07042-0599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-669-2820
Provider Business Mailing Address Fax Number:
973-669-2930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 NORTHFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
WEST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07052-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-669-2820
Provider Business Practice Location Address Fax Number:
973-669-2930
Provider Enumeration Date:
09/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PAIGE
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
973-669-2820

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  25MA056219 , 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)





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