1013062819 NPI number — DR. ANDREW PETER SLOOTMAKER D.C.

Table of content: (NPI 1912770157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013062819 NPI number — DR. ANDREW PETER SLOOTMAKER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLOOTMAKER
Provider First Name:
ANDREW
Provider Middle Name:
PETER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1013062819
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKAWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07866-4307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-784-4274
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07834-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-944-4866
Provider Business Practice Location Address Fax Number:
973-794-5133
Provider Enumeration Date:
01/24/2007

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: 111N00000X , with the licence number:  38MC00612500 , 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: P3678311 . This is a "OXFORD PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9159921 . This is a "CIGNA PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1217969 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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