1639349285 NPI number — JOHN J HOSAY MD PA

Table of content: (NPI 1639349285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639349285 NPI number — JOHN J HOSAY MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN J HOSAY MD 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:
1639349285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2555 KENNEDY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07304-2165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-433-9666
Provider Business Mailing Address Fax Number:
201-432-9647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2555 KENNEDY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07304-2165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-433-9666
Provider Business Practice Location Address Fax Number:
201-432-9647
Provider Enumeration Date:
03/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOSAY JR
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
201-433-9666

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  25MA03641100 , 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: 2679809 . This is a "MEDICAID GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1862201 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".