1003956806 NPI number — TRC REALTY CORP

Table of content: (NPI 1003956806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003956806 NPI number — TRC REALTY CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRC REALTY CORP
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:
6
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:
1003956806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 LAUREL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEANSBURG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07734-1122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-471-1600
Provider Business Mailing Address Fax Number:
732-471-1077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 LAUREL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEANSBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07734-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-471-1600
Provider Business Practice Location Address Fax Number:
732-471-1077
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAPPADONA
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
ADMINISTRATOR OWNER
Authorized Official Telephone Number:
732-471-1600

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  90115 , 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: 7279001 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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