1225287113 NPI number — HENRY J AUSTIN HEALTH CENTER, INC

Table of content: (NPI 1003909375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225287113 NPI number — HENRY J AUSTIN HEALTH CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRY J AUSTIN HEALTH CENTER, 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:
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:
1225287113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 N WARREN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08618-4741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-278-5900
Provider Business Mailing Address Fax Number:
609-695-3532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1544 KUSER RD
Provider Second Line Business Practice Location Address:
SUITE C 6& 7
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08619-3830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-585-4606
Provider Business Practice Location Address Fax Number:
609-585-4608
Provider Enumeration Date:
09/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
YULL
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
HR MANAGER
Authorized Official Telephone Number:
609-278-5950

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  24227 , 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: 24227 . This is a "STATE LIC NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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