1356366124 NPI number — DANA R BANU MD

Table of content: DANA R BANU MD (NPI 1356366124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356366124 NPI number — DANA R BANU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANU
Provider First Name:
DANA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1356366124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 PONOCO ROAD
Provider Second Line Business Mailing Address:
SUITE 317
Provider Business Mailing Address City Name:
DENVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-627-2650
Provider Business Mailing Address Fax Number:
973-627-8383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 PONOCO ROAD
Provider Second Line Business Practice Location Address:
SUITE 317
Provider Business Practice Location Address City Name:
DENVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-627-2650
Provider Business Practice Location Address Fax Number:
973-627-8383
Provider Enumeration Date:
07/13/2006

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: 207R00000X , with the licence number:  25MA06257400 , 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: 6643809 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: IP226 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 110120473 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3T3821 . This is a "WELLCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 526293 . This is a "MEDICARE ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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