1992753479 NPI number — HAMILTON GENERAL SURGERY LLC

Table of content: (NPI 1992753479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992753479 NPI number — HAMILTON GENERAL SURGERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMILTON GENERAL SURGERY 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:
1992753479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 WHITE HORSE AVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08610-1411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-585-3900
Provider Business Mailing Address Fax Number:
609-585-3365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 WHITE HORSE AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08610-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-585-3900
Provider Business Practice Location Address Fax Number:
609-585-3365
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VASWANI
Authorized Official First Name:
VIJAY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
609-585-3900

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  25MA072849000 , 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: 2K3779 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2720742 . This is a "AETNA USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2153551 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2531958 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8631107 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100003627000 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2720742 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".




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