1003935693 NPI number — NORTHEASTERN ANESTHESIA OF NEW JERSEY, PC

Table of content: DR. ROSA ELENA PELAEZ-SHELTON DDS, MDS (NPI 1700014701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003935693 NPI number — NORTHEASTERN ANESTHESIA OF NEW JERSEY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEASTERN ANESTHESIA OF NEW JERSEY, 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:
1003935693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 N BEDFORD RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MOUNT KISCO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10549-2553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-666-8866
Provider Business Mailing Address Fax Number:
914-666-6777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 FRANKLIN TPKE
Provider Second Line Business Practice Location Address:
SURGICARE SURGICAL ASSOCIATES OF MAHWAH, LLC
Provider Business Practice Location Address City Name:
MAHWAH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07430-3516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-666-8866
Provider Business Practice Location Address Fax Number:
914-666-6777
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COHN
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-666-8866

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0129453 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com