1891874723 NPI number — ROCHELLE PARK MEDICAL CENTER PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891874723 NPI number — ROCHELLE PARK MEDICAL CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCHELLE PARK MEDICAL CENTER 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:
1891874723
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:
96 PARKWAY
Provider Second Line Business Mailing Address:
ROCHELLE PARK MEDICAL CENTER PA
Provider Business Mailing Address City Name:
ROCHELLE PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-291-1010
Provider Business Mailing Address Fax Number:
201-587-0313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96 PARKWAY
Provider Second Line Business Practice Location Address:
ROCHELLE PARK MEDICAL CENTER PA
Provider Business Practice Location Address City Name:
ROCHELLE PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-291-1010
Provider Business Practice Location Address Fax Number:
201-587-0313
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IMBORNONE
Authorized Official First Name:
PETER
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
201-291-1010

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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