1932592441 NPI number — NEW PROVIDENCE HEALTHCARE ASSOCIATES INC.

Table of content: (NPI 1932592441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932592441 NPI number — NEW PROVIDENCE HEALTHCARE ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW PROVIDENCE HEALTHCARE ASSOCIATES 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:
1932592441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5627 ALLENTOWN RD
Provider Second Line Business Mailing Address:
UNIT 100
Provider Business Mailing Address City Name:
CAMP SPRINGS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20746-4520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-241-0255
Provider Business Mailing Address Fax Number:
240-455-0247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 FLEET ST STE 136
Provider Second Line Business Practice Location Address:
C/O NEW PROVIDENCE HEALTHCARE ASSOCIATES INC.
Provider Business Practice Location Address City Name:
OXON HILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20745-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-899-8910
Provider Business Practice Location Address Fax Number:
301-899-8915
Provider Enumeration Date:
03/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CARTWRIGHT
Authorized Official First Name:
SHANIQUE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/MEDICAL DIRECTOR
Authorized Official Telephone Number:
301-633-3175

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MD0072664 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X , with the licence number: MD0072664 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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