1609049501 NPI number — MANOUCHER KATEBIAN, M.D. PA

Table of content: (NPI 1609049501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609049501 NPI number — MANOUCHER KATEBIAN, M.D. PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANOUCHER KATEBIAN, M.D. PA
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:
1609049501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
274 SUMMIT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HACKENSACK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07601-1432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-342-3800
Provider Business Mailing Address Fax Number:
201-343-7320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
274 SUMMIT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-1432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-342-3800
Provider Business Practice Location Address Fax Number:
201-343-7320
Provider Enumeration Date:
04/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KATEBIAN
Authorized Official First Name:
MANOUCHER
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
201-342-3800

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA02875800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MA02875800 , 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: NJ6763 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: BS735 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 442062045 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2914204 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".