1003978347 NPI number — ADVANCED CARE INTERNAL MEDICINE L.L.C.

Table of content: (NPI 1003978347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003978347 NPI number — ADVANCED CARE INTERNAL MEDICINE L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CARE INTERNAL MEDICINE L.L.C.
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:
1003978347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
751 GARNET LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST STROUDSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18301-8495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-900-0471
Provider Business Mailing Address Fax Number:
570-730-4415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 GARNET LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18301-8495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-900-0471
Provider Business Practice Location Address Fax Number:
570-730-4415
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FUENTES
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
NICOLAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-900-0471

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MA060596 , 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)





Copyright © 2007-2025 www.npivalidator.com