1659463180 NPI number — RIACHI, P.C.

Table of content: DR. SAMUEL GRANDINETTI DDS (NPI 1558405225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659463180 NPI number — RIACHI, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIACHI, P.C.
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:
1659463180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 WOODLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07090-1826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-723-1234
Provider Business Mailing Address Fax Number:
908-928-0262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
128 S EUCLID AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07090-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-928-1234
Provider Business Practice Location Address Fax Number:
908-928-0262
Provider Enumeration Date:
09/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIACHI
Authorized Official First Name:
LABIB
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
908-723-1234

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  25MA07007000 , 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)