1013982719 NPI number — CITY OF VINELAND-HEALTH

Table of content: (NPI 1013982719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013982719 NPI number — CITY OF VINELAND-HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF VINELAND-HEALTH
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:
1013982719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 E. WOOD STREET
Provider Second Line Business Mailing Address:
PO BOX 1508
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08360-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-794-4000
Provider Business Mailing Address Fax Number:
856-405-4608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 MONTROSE STREET
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360-1508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-794-4000
Provider Business Practice Location Address Fax Number:
856-692-1872
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FANUCCI
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
ROMEO
Authorized Official Title or Position:
MAYOR
Authorized Official Telephone Number:
856-794-4000

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  70601 , 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: 3690504 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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