1629304290 NPI number — COGENT HEALTHCARE OF NEW JERSEY, PC

Table of content: (NPI 1629304290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629304290 NPI number — COGENT HEALTHCARE OF NEW JERSEY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COGENT HEALTHCARE OF NEW JERSEY, PC
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:
1629304290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5410 MARYLAND WAY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-371-5765
Provider Business Mailing Address Fax Number:
888-241-1404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 PROSPECT 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:
07601-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-371-5765
Provider Business Practice Location Address Fax Number:
888-241-1404
Provider Enumeration Date:
11/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
AMI
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PROVIDER ENROLLMENT COORDINATOR
Authorized Official Telephone Number:
615-371-5765

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0217344 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".