1821278433 NPI number — GREGORY G EWING PA

Table of content: GREGORY G EWING PA (NPI 1821278433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821278433 NPI number — GREGORY G EWING PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EWING
Provider First Name:
GREGORY
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1821278433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
695 US HIGHWAY 46
Provider Second Line Business Mailing Address:
STE 400A
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07004-1568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-826-8291
Provider Business Mailing Address Fax Number:
888-972-6480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 COURTYARD DR
Provider Second Line Business Practice Location Address:
BUILDING 600
Provider Business Practice Location Address City Name:
HILLSBOROUGH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08844-4256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-722-0030
Provider Business Practice Location Address Fax Number:
908-722-0188
Provider Enumeration Date:
11/12/2007

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: 363AS0400X , with the licence number:  25MP00029600 , 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: 527111 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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