1821138520 NPI number — RHEUMATOLOGY & ARTHRITIS ASSOC., PC

Table of content: (NPI 1821138520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821138520 NPI number — RHEUMATOLOGY & ARTHRITIS ASSOC., PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHEUMATOLOGY & ARTHRITIS ASSOC., PC
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:
1821138520
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:
30 JACKSON RD
Provider Second Line Business Mailing Address:
SUITE D2
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08055-9283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-654-5100
Provider Business Mailing Address Fax Number:
609-654-5922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 JACKSON RD
Provider Second Line Business Practice Location Address:
SUITE D2
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08055-9283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-654-5100
Provider Business Practice Location Address Fax Number:
609-654-5922
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HYMOWITZ
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
609-654-5100

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA03749200 , 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: 0907732005 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4987306 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: F03520 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0531814000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0531814000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 208039 . This is a "UNIFORMED FAMILY SVCS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 38688 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P379360 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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