1922210806 NPI number — MARTIN WHITEMAN D.O. P.A.

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 1922210806 NPI number — MARTIN WHITEMAN D.O. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN WHITEMAN D.O. P.A.
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:
MARTIN WHITEMAN D.O. P.A.
Provider Other Organization Name Type Code:
3
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:
1922210806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 326
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN LAKES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07417-0326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-606-4754
Provider Business Mailing Address Fax Number:
201-847-0059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 FALLING OAKS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08753-8408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-606-4754
Provider Business Practice Location Address Fax Number:
201-847-0059
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITEMAN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
732-606-4754

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MA59181 , 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: 5458102 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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