1255435269 NPI number — DR. RANDALL EUGENE PITONE MD

Table of content: DR. RANDALL EUGENE PITONE MD (NPI 1255435269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255435269 NPI number — DR. RANDALL EUGENE PITONE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITONE
Provider First Name:
RANDALL
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1255435269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2038 CARMEL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-825-6810
Provider Business Mailing Address Fax Number:
856-765-0252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2038 CARMEL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-825-6810
Provider Business Practice Location Address Fax Number:
856-765-0252
Provider Enumeration Date:
09/11/2006

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: 2084P0800X , with the licence number:  0101058768 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 31033 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0802X , with the licence number: 25MA07963400 , 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: 010057299 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4088360 . This is a "MAGELLAN NAVIGATOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010154618 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 260050527 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4088360 . This is a "MAGELLAN SUMMIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605028 . This is a "TRICARE NORTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010057345 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 620582605 . This is a "BEECH STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 334969 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3894689 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4088360 . This is a "MAGELLAN PINNACLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010149673 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 351654200 . This is a "DOL WORKERS COMP" identifier . This identifiers is of the category "OTHER".




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