1548347446 NPI number — NINA K REGEVIK M.D.

Table of content: NINA K REGEVIK M.D. (NPI 1548347446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548347446 NPI number — NINA K REGEVIK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REGEVIK
Provider First Name:
NINA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1548347446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W 43RD ST APT 12B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10036-4332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-324-5022
Provider Business Mailing Address Fax Number:
732-324-5373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 NEW BRUNSWICK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08861-3654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-324-5022
Provider Business Practice Location Address Fax Number:
732-324-4838
Provider Enumeration Date:
11/01/2006

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: 207R00000X , with the licence number:  25MA05475300 , 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: 1033894 . This is a "HORIZON NJ HEALTH#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K4841 . This is a "HEALTHNET#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 91002284900 . This is a "AMERICHOICE#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0532587000 . This is a "AMERIHEALTH#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 18431 . This is a "AMERIGROUP#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3820240 . This is a "OXFORD #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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