1770650947 NPI number — DR. JOSEPH ANTHONY MEGARA III DPM

Table of content: LARRY T HAWKINS OT (NPI 1124196373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770650947 NPI number — DR. JOSEPH ANTHONY MEGARA III DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEGARA
Provider First Name:
JOSEPH
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DPM
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:
1770650947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 GROVE AVE
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
WEST DEPTFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08086-2557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-579-8674
Provider Business Mailing Address Fax Number:
856-579-8676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 GROVE AVE
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
WEST DEPTFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08086-2557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-579-8674
Provider Business Practice Location Address Fax Number:
856-579-8676
Provider Enumeration Date:
11/30/2006

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: 213ES0103X , with the licence number:  25MD00273100 , 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: 1951002 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: G3597421 . This is a "OXFORD GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 273402206 . This is a "GRUP TAX ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 91001485801 . This is a "AMERICHOICE GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3597426 . This is a "OXFORD INDIVIDUAL NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0002046 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2335837000 . This is a "AMERIHEALTH NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K5088 . This is a "TRICARE AND HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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