1447916275 NPI number — MR. MICHAEL CEBULKO HAD

Table of content: MR. MICHAEL CEBULKO HAD (NPI 1447916275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447916275 NPI number — MR. MICHAEL CEBULKO HAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CEBULKO
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
HAD
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:
1447916275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 PASSAIC AVE APT 6A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASSAIC
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07055-3609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-873-1896
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
653 ROUTE 46 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07004-1589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-227-0750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2021

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: 237700000X , with the licence number:  25MG00157800 , 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)