1972673713 NPI number — HAND SURGERY & REHABILITATION CENTER OF NEW JERSEY, PA

Table of content: (NPI 1972673713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972673713 NPI number — HAND SURGERY & REHABILITATION CENTER OF NEW JERSEY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAND SURGERY & REHABILITATION CENTER OF NEW JERSEY, PA
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:
1972673713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 SAGEMORE DRIVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-983-4263
Provider Business Mailing Address Fax Number:
856-983-9362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 SAGEMORE DR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MARLTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08053-4307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-983-4263
Provider Business Practice Location Address Fax Number:
856-983-0674
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALLET
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-983-4263

Provider Taxonomy Codes

  • Taxonomy code: 2086S0105X , with the licence number:  24019 , 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: 34931 . This is a "AETNA GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9661087 . This is a "GHI GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: IL2400 . This is a "HEALTHNET GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0550440000 . This is a "KEYSTONE GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3733521B . This is a "CIGNA GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 658819 . This is a "HIGHMARK GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 714037 . This is a "HORIZON GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0201950001 . This is a "MEDICARE NSC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0550440000 . This is a "AMERIHEALTH GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 736734 . This is a "UNITED HEALTH GROUP NUMBE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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