1770539058 NPI number — 1450 ASSOCIATES, LLC

Table of content: (NPI 1770539058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770539058 NPI number — 1450 ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1450 ASSOCIATES, LLC
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:
CENTER FOR DIAGNOSTIC IMAGING
Provider Other Organization Name Type Code:
3
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:
1770539058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1550 E CHESTNUT AVE
Provider Second Line Business Mailing Address:
BUILDING 4, SUITE C
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08361-8485
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-794-8664
Provider Business Mailing Address Fax Number:
856-794-2671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1119 HIGHWAY 77
Provider Second Line Business Practice Location Address:
SUITE 2C
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08302-3649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-453-1555
Provider Business Practice Location Address Fax Number:
856-453-0255
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
SATISH
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
856-794-8664

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  23367 , 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: 2237566000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: S992861 . This is a "CIGNA/AIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16802 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2K3084 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: A2891314 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8667802 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01000441402 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1156711 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: CJ3996 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 077 . This is a "HEALTHNET/CARECORE" identifier . This identifiers is of the category "OTHER".




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