1740284595 NPI number — DR. ALBERT MARTIN DIPASQUALE MD

Table of content: DR. ALBERT MARTIN DIPASQUALE MD (NPI 1740284595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740284595 NPI number — DR. ALBERT MARTIN DIPASQUALE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIPASQUALE
Provider First Name:
ALBERT
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1740284595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 EASTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SICKLERVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08081-4309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-670-0638
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
813 EAST GATE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT LAUREL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-222-9119
Provider Business Practice Location Address Fax Number:
856-222-9907
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  25MA04524300 , 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: 2329409 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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