1609874296 NPI number — KAREN ANN QUINLAN MEMORIAL FOUNDATION

Table of content: JEFFREY STEPHEN GEORGE MD (NPI 1366403289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609874296 NPI number — KAREN ANN QUINLAN MEMORIAL FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAREN ANN QUINLAN MEMORIAL FOUNDATION
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:
6
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:
1609874296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 SPARTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07860-2614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-383-0115
Provider Business Mailing Address Fax Number:
973-383-6889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 MEMORIAL PKWY
Provider Second Line Business Practice Location Address:
BLDG 303 SUITE 303A
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08865-2748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-383-0115
Provider Business Practice Location Address Fax Number:
973-383-6889
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CLAYTON
Authorized Official First Name:
CECELIA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
973-383-0115

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  22270 , 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: 7711808 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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