1932369378 NPI number — MOUNTAIN VIEW FAMILY MEDICINE LLC

Table of content: (NPI 1932369378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932369378 NPI number — MOUNTAIN VIEW FAMILY MEDICINE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN VIEW FAMILY MEDICINE 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:
1932369378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
426 ROUTE 515
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERNON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07462-3027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-764-5666
Provider Business Mailing Address Fax Number:
973-764-5778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
426 ROUTE 515
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07462-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-764-5666
Provider Business Practice Location Address Fax Number:
973-764-5778
Provider Enumeration Date:
06/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MARION
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
973-764-5666

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00452700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MB073164 , 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: 5603A1 . This is a "WELL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5996410 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2666266 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3704975 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1846484 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5598108 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7004396 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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