1427098193 NPI number — MISS SUSAN M SLATER MPT,OCS

Table of content: MISS SUSAN M SLATER MPT,OCS (NPI 1427098193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427098193 NPI number — MISS SUSAN M SLATER MPT,OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLATER
Provider First Name:
SUSAN
Provider Middle Name:
M
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MPT,OCS
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:
1427098193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E UNION AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOUND BROOK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08805-1762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-868-9018
Provider Business Mailing Address Fax Number:
732-868-5112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E UNION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOUND BROOK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08805-1762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-868-9018
Provider Business Practice Location Address Fax Number:
732-868-5112
Provider Enumeration Date:
06/08/2006

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: 225100000X , with the licence number:  40QA00456200 , 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: 650022084 . This is a "PALMETTO GBA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0004562NJ01 . This is a "ANTHEM HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 000815669 . This is a "AMERIHEALTH CASUALTY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 129266178 . This is a "TRICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223631294 . This is a "HORIZON BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: TS151 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 115946000 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223631294 . This is a "MAGNACARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5183705 . This is a "NORTH AMERICAN ADMIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5183705 . This is a "CCN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0552319 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 369972 . This is a "ONE HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1043757 . This is a "FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1K2449 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2938 . This is a "MASTERCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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