1003887704 NPI number — ROBERT KOCH ILOWITE D.O.

Table of content: ROBERT KOCH ILOWITE D.O. (NPI 1003887704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003887704 NPI number — ROBERT KOCH ILOWITE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ILOWITE
Provider First Name:
ROBERT
Provider Middle Name:
KOCH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1003887704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 OMNI DR
Provider Second Line Business Mailing Address:
THE DERMATOLOGY CENTER
Provider Business Mailing Address City Name:
HILLSBOROUGH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08844-4528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-359-6685
Provider Business Mailing Address Fax Number:
908-359-0649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 OMNI DR
Provider Second Line Business Practice Location Address:
THE DERMATOLOGY CENTER
Provider Business Practice Location Address City Name:
HILLSBOROUGH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08844-4528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-359-6685
Provider Business Practice Location Address Fax Number:
908-359-0649
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  25MB06116900 , 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: 1003887704 . This is a "NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223539248 . This is a "TAX ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0809116000 . This is a "AMERIHEALTH GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4843856004 . This is a "CIGNA HEALTHCARE PAL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 578537 . This is a "AETNA HEALTH, INC." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 070014217 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K9800 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P1003739 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1427926 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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