1902286982 NPI number — PAFACOM, INC.

Table of content: (NPI 1902286982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902286982 NPI number — PAFACOM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAFACOM, INC.
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:
1902286982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 W FOREST GROVE RD
Provider Second Line Business Mailing Address:
BUILDING 3C
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08360-1501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-696-1661
Provider Business Mailing Address Fax Number:
856-691-6560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 ALLOWAY RD
Provider Second Line Business Practice Location Address:
APARTMENT 203
Provider Business Practice Location Address City Name:
WOODSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08098-1033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-624-4426
Provider Business Practice Location Address Fax Number:
856-691-6560
Provider Enumeration Date:
06/04/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VERNAMONTI
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
TY
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
856-696-1661

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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