1790813145 NPI number — MICHAEL P WEINGARTEN DO PA

Table of content: (NPI 1790813145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790813145 NPI number — MICHAEL P WEINGARTEN DO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL P WEINGARTEN DO PA
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:
1790813145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
745 HIGHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMYRA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08065-1922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-829-4225
Provider Business Mailing Address Fax Number:
856-829-7016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
745 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMYRA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08065-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-829-4225
Provider Business Practice Location Address Fax Number:
856-829-7016
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEINGARTEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
DIRECT OWNER
Authorized Official Telephone Number:
856-829-4225

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MB025957 , 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: 0084811001 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0084811001 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1130200 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB4187 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 140759 . This is a "DEVON NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4298684 . This is a "AETNA ELECTRONIC SUB ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: P560037 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: F05065 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1099729 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com