1720080948 NPI number — MEDIDYNE CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720080948 NPI number — MEDIDYNE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDIDYNE CORP
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:
1720080948
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:
80 LITTLE FALLS RD
Provider Second Line Business Mailing Address:
STE 5
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07004-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-882-4567
Provider Business Mailing Address Fax Number:
973-882-3637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 LITTLE FALLS RD
Provider Second Line Business Practice Location Address:
STE 5
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07004-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-882-4567
Provider Business Practice Location Address Fax Number:
973-882-3637
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
L.
Authorized Official First Name:
GAYLE
Authorized Official Middle Name:
UHLENBURG
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-882-4567

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G6627 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1520683 . This is a "UNITED MINE WORKERS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 3097955 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01629632 0004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01628697 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5526019000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8046301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80-00026 . This is a "EVERCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0000888816 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 608653 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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