1568447241 NPI number — HAIDY BEHMAN MD

Table of content: HAIDY BEHMAN MD (NPI 1568447241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568447241 NPI number — HAIDY BEHMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEHMAN
Provider First Name:
HAIDY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1568447241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 PULASKI AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARTERET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07008-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-541-0340
Provider Business Mailing Address Fax Number:
732-541-1451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48 PULASKI AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTERET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07008-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-541-0340
Provider Business Practice Location Address Fax Number:
732-541-1451
Provider Enumeration Date:
12/14/2005

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:  25MA06382500 , 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: 16899 . This is a "AMERICAID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: MI000039001 . This is a "AMERICHOICE #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 203552661 . This is a "TAX IDENTIFICATION #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2235442 . This is a "AETNA HMO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1083247 . This is a "HORIZON NJ HEALTH #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7067003 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010063825NJ01 . This is a "ANTHEM #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5464427 . This is a "AETNA PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 632N01 . This is a "EMPIRE #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8000170 . This is a "GHI PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P1927438 . This is a "OXFORD #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0051886000 . This is a "AMERIHEALTH #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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