1245254457 NPI number — MR. REED BRIAN LERMAN DC

Table of content: (NPI 1407294440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245254457 NPI number — MR. REED BRIAN LERMAN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LERMAN
Provider First Name:
REED
Provider Middle Name:
BRIAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1245254457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 363
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHIP BOTTOM
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08008-0248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-661-0101
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 E BAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANAHAWKIN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08050-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-661-0101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006

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: 111N00000X , with the licence number:  38MC00576400 , 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: 203493031 . This is a "BC/BS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7855827 . This is a "AETNA PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1163556 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2795579000 . This is a "AMERIHEALTH IND. PROVIDER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2795581000 . This is a "AMERIHEALTH VENDOR BILLNG" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 097148UW3 . This is a "MEDICARE IND. PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 097149 . This is a "LEGACY PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1245254457 . This is a "PROVIDER NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1326173782 . This is a "GROUP NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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