1811978141 NPI number — ALLCARE MEDICAL SNJ, LLC

Table of content: (NPI 1811978141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811978141 NPI number — ALLCARE MEDICAL SNJ, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLCARE MEDICAL SNJ, 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:
ALLCARE MEDICAL
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:
1811978141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
89 S COMMERCE WAY
Provider Second Line Business Mailing Address:
SUITE 940
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18017-8952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-856-4433
Provider Business Mailing Address Fax Number:
855-856-4477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 S COMMERCE WAY
Provider Second Line Business Practice Location Address:
SUITE 940
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-8952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-856-4433
Provider Business Practice Location Address Fax Number:
855-856-4477
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
WINTHROP
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-244-4660

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 235920 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 81747 . This is a "NORTHWOOD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0001138000 . This is a "KEYSTONE HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0016829 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: MI0000352-02 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0001138000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0001138000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0001138000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1009356340003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41745 . This is a "UNIVERSITY HEALTHPLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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