1730280199 NPI number — MEADOWLANDS CHIROPRACTIC CENTER, P.A.

Table of content: (NPI 1730280199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730280199 NPI number — MEADOWLANDS CHIROPRACTIC CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEADOWLANDS CHIROPRACTIC CENTER, P.A.
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:
1730280199
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:
360 RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNDHURST
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07071-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-438-2404
Provider Business Mailing Address Fax Number:
201-438-5739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNDHURST
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07071-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-438-2404
Provider Business Practice Location Address Fax Number:
201-438-5739
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZACCARIA
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
201-438-2404

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00131700 , 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: 2995603 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0936093 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1076624 . This is a "NJ HEALTH HORIZON HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4066261 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8211-161 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NJ01317 . This is a "GUARDIAN HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 460651 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: FZ0X3W0210 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1006489 . This is a "AMERICAN SPECIALTY HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P538623 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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