1376948695 NPI number — CALDWELL-WEST CALDWELL

Table of content: (NPI 1376948695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376948695 NPI number — CALDWELL-WEST CALDWELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALDWELL-WEST CALDWELL
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:
1376948695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 GRAY ST
Provider Second Line Business Mailing Address:
HARRISON SCHOOL
Provider Business Mailing Address City Name:
WEST CALDWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07006-7615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-228-5291
Provider Business Mailing Address Fax Number:
973-830-2310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 GRAY ST
Provider Second Line Business Practice Location Address:
HARRISON SCHOOL
Provider Business Practice Location Address City Name:
WEST CALDWELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07006-7615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-228-5291
Provider Business Practice Location Address Fax Number:
973-830-2310
Provider Enumeration Date:
10/29/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PALOZZOLA
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF SPECIAL SERVICES
Authorized Official Telephone Number:
973-228-5291

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , 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)