1336558162 NPI number — EMILE I. RANGEL, MD, LLC

Table of content: DR. EMILEE HURST ANTHONY OD (NPI 1619864618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336558162 NPI number — EMILE I. RANGEL, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMILE I. RANGEL, MD, LLC
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:
1336558162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 PALISADE AVE., APT. 10B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-240-2707
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6804 BERGENLINE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BERGEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07093-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-240-2707
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RANGEL
Authorized Official First Name:
EMILE
Authorized Official Middle Name:
IVAN
Authorized Official Title or Position:
MEDICAL DIRECTOR/PRESIDENT
Authorized Official Telephone Number:
201-240-2707

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  MA066179 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: MA066179 , 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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