1356553093 NPI number — LAKEVIEW PEDIATRICS

Table of content: ASHLEY ALLEN HENDRIX MD (NPI 1457524209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356553093 NPI number — LAKEVIEW PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKEVIEW PEDIATRICS
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:
1356553093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LAKEVIEW PEDIATRICS
Provider Second Line Business Mailing Address:
266 LAKEVIEW AVE
Provider Business Mailing Address City Name:
CLIFTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-340-6225
Provider Business Mailing Address Fax Number:
973-340-0665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LAKEVIEW PEDIATRICS
Provider Second Line Business Practice Location Address:
266 LAKEVIEW AVE
Provider Business Practice Location Address City Name:
CLIFTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-340-6225
Provider Business Practice Location Address Fax Number:
973-340-0665
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KORTOWSKA
Authorized Official First Name:
MALGORZATA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
973-340-6225

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MA065909 , 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: 7560401 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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