1407853310 NPI number — DR. MITCHELL FERGES

Table of content: DR. MITCHELL FERGES (NPI 1407853310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407853310 NPI number — DR. MITCHELL FERGES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGES
Provider First Name:
MITCHELL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1407853310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 CLYDE RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08873-5032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-873-9200
Provider Business Mailing Address Fax Number:
732-873-1699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 CLYDE RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08873-5032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-873-9200
Provider Business Practice Location Address Fax Number:
732-873-1699
Provider Enumeration Date:
07/07/2005

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: 174400000X , with the licence number:  25MA03204300 , 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: 110083490 . This is a "RAILROAD MDCR #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0K3007 . This is a "HEALTHNET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4V5041 . This is a "EMPIRE BC/BS E. BRUNS. #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: TS058 . This is a "OXFORD #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0099027000 . This is a "AMERIHEALTH #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2499585 . This is a "GHI PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1175203 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2243283 . This is a "AETNA HMO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 15235 . This is a "AMERICAID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4093715 . This is a "AETNA PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 40A653 . This is a "EMPIRE BC/BS SOMERSET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com