1013296821 NPI number — DR. DUNGO ASSOCIATES, P.C.

Table of content: DR. RAUL N. MANDLER M.D. (NPI 1366576803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013296821 NPI number — DR. DUNGO ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. DUNGO ASSOCIATES, P.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:
1013296821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 477
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07303-0477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07302-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-653-1144
Provider Business Practice Location Address Fax Number:
201-653-6104
Provider Enumeration Date:
08/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DUNGO
Authorized Official First Name:
JOVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-653-1144

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  25MA04298200 , 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: 118041 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 450454 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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