1023543501 NPI number — QMANJ, INC.

Table of content: (NPI 1023543501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023543501 NPI number — QMANJ, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QMANJ, INC.
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:
1023543501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 CINNAMINSON AVE
Provider Second Line Business Mailing Address:
BLDG B
Provider Business Mailing Address City Name:
PALMYRA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08065-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-735-1034
Provider Business Mailing Address Fax Number:
856-727-8899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 HOMEWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08077-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-797-2278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARNES
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
856-735-1011

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  GH1414 , 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)