1841291200 NPI number — PRO MEDICAL EAST, LLC

Table of content: (NPI 1841291200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841291200 NPI number — PRO MEDICAL EAST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO MEDICAL EAST, 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:
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:
1841291200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1950 RUTGERS UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-4537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-657-9600
Provider Business Mailing Address Fax Number:
732-657-9400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7165 OGONTZ AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19138-2047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-657-9600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BERMAN
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
732-348-1119

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2272955 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 246014 . This is a "HIGHMARK BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 540H104220 . This is a "MICHIGAN BC/BS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P2723785 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 90171 . This is a "MINN BC/BS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: DM1174 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54432383 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5164 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 629315 . This is a "ANTHEM BC OF VIRGINIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1163297 . This is a "MERCY HEALTH PLANS - MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 41731600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 625683800 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8704805 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005164000 . This is a "IBX" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1861130 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8200594 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2723785 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000246014 . This is a "HIGHMARK BC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 010145988 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 226221 . This is a "ADVANTRA CARELINK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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