1043558471 NPI number — PERINATAL & GYNECOLOGICAL SONOGRAPHY SERVICES, LLC

Table of content: (NPI 1043558471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043558471 NPI number — PERINATAL & GYNECOLOGICAL SONOGRAPHY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERINATAL & GYNECOLOGICAL SONOGRAPHY SERVICES, LLC
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:
1043558471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 ROCK RD # 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ROCK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07452-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-762-4805
Provider Business Mailing Address Fax Number:
201-326-5613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1860 SPRINGFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07040-2905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-762-4805
Provider Business Practice Location Address Fax Number:
201-326-5613
Provider Enumeration Date:
01/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
CAMILLE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
973-762-4805

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X , with the licence number:  25MA06233200 , 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)





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