1760439772 NPI number — CITY OF VINELAND

Table of content: (NPI 1760439772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760439772 NPI number — CITY OF VINELAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF VINELAND
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:
1760439772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 E WOOD ST PO BOX 1508
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08362-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-794-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 E WOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360-3722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-794-4000
Provider Business Practice Location Address Fax Number:
856-794-1159
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FANUCCI
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
ROMEO
Authorized Official Title or Position:
MAYOR
Authorized Official Telephone Number:
856-794-4000

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  VINE00614 , 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: 144056 . This is a "LIBERTY MUTUAL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0455452000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0002215823 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0455452006 . This is a "KEYSTONE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1038041 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0027752 . This is a "AETNA HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 590007186 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2505606 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86310 . This is a "AMERIGROUP-NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 90000338200 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: OX00NL3125 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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