1144280017 NPI number — PATIENT CARE NEW JERSEY, INC.

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 1144280017 NPI number — PATIENT CARE NEW JERSEY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATIENT CARE NEW JERSEY, INC.
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:
6
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:
1144280017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9510 ORMSBY STATION RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-4081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-891-1425
Provider Business Mailing Address Fax Number:
502-891-1427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 QUINCY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASSAIC
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07055-6608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-365-5200
Provider Business Practice Location Address Fax Number:
973-365-0729
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEDIGO
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP REIMBURSEMENT
Authorized Official Telephone Number:
502-891-1425

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  22592 , 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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