1982646634 NPI number — CMC PSYCHIATRIC ASSOCIATES, PC

Table of content: (NPI 1982646634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982646634 NPI number — CMC PSYCHIATRIC ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CMC PSYCHIATRIC ASSOCIATES, PC
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:
1982646634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 FEDERAL STREET
Provider Second Line Business Mailing Address:
SW-200
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08103-1155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-356-4924
Provider Business Mailing Address Fax Number:
856-382-6455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 COOPER PLZ
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08103-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-342-2328
Provider Business Practice Location Address Fax Number:
856-541-6137
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAZZARELLI
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CHIEF MEDICAL OFFICE
Authorized Official Telephone Number:
856-968-7858

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , 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: 0090557000 . This is a "AMERIHEALTH GRP#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3030601 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6415903 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9476 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00900557000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100775601 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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