1922013366 NPI number — BOROUGH OF WILDWOOD CREST

Table of content: (NPI 1922013366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922013366 NPI number — BOROUGH OF WILDWOOD CREST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOROUGH OF WILDWOOD CREST
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:
1922013366
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:
6101 PACIFIC AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILDWOOD CREST
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08260-4113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6101 PACIFIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILDWOOD CREST
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08260-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-522-5176
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YECCO
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
BOROUGH CLERK
Authorized Official Telephone Number:
609-522-5176

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3416L0300X , 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: 91000989200 . This is a "AMERICHOICE OF NJ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30020586 . This is a "KEYSTONE MERCY HEALTH PLA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3181877 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9110909 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2159308000 . This is a "AMERIHEALTH HMO NJ DE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00007707 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1172598 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: A28787660 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".




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