1437340932 NPI number — PARAMUS FOOT AND ANKLE CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437340932 NPI number — PARAMUS FOOT AND ANKLE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAMUS FOOT AND ANKLE CENTER
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:
1437340932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
261 ENGLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TENAFLY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07670-2138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-568-6977
Provider Business Mailing Address Fax Number:
201-568-7567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 W RIDGEWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE G1
Provider Business Practice Location Address City Name:
PARAMUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07652-2359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-445-4900
Provider Business Practice Location Address Fax Number:
201-568-7567
Provider Enumeration Date:
08/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAGEN
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-445-4900

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  MD1961 , 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: 3335213 . This is a "AETNA ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3630953 . This is a "OXFORD ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6202429 . This is a "GHI ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8895263 . This is a "CIGNA ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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