1346906179 NPI number — OPHELIA MEDICAL GROUP NJ PC

Table of content: (NPI 1346906179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346906179 NPI number — OPHELIA MEDICAL GROUP NJ PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPHELIA MEDICAL GROUP NJ PC
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:
1346906179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
228 PARK AVE S STE 15314
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10003-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-585-2144
Provider Business Mailing Address Fax Number:
833-228-5591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 US HIGHWAY 206
Provider Second Line Business Practice Location Address:
BUILDING 3, SUITE #4
Provider Business Practice Location Address City Name:
FLANDERS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07836-9287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-585-2144
Provider Business Practice Location Address Fax Number:
833-228-5591
Provider Enumeration Date:
11/16/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CMO
Authorized Official Telephone Number:
347-857-8015

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)