1013053750 NPI number — MORRIS SUSSEX FAMILY PRACTICE, PC

Table of content: (NPI 1013053750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013053750 NPI number — MORRIS SUSSEX FAMILY PRACTICE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRIS SUSSEX FAMILY PRACTICE, 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:
1013053750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
694 STATE ROUTE 15 S
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
LAKE HOPATCONG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07849-2249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-663-8899
Provider Business Mailing Address Fax Number:
973-663-9511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
694 STATE ROUTE 15 S
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LAKE HOPATCONG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07849-2249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-663-8899
Provider Business Practice Location Address Fax Number:
973-663-9511
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LUCATORTO
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-663-8899

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MB60950 , 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: 7105002 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2355303001 . This is a "AMERIHEALTH HMO PRAC ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com