1073766341 NPI number — CRANBURY THERAPY LLC

Table of content: (NPI 1073766341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073766341 NPI number — CRANBURY THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRANBURY THERAPY 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:
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:
1073766341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 155
Provider Second Line Business Mailing Address:
70 SOUTH MAIN STREET, SUITE 1C
Provider Business Mailing Address City Name:
CRANBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08512-0155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-655-0420
Provider Business Mailing Address Fax Number:
609-655-8721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1C
Provider Business Practice Location Address City Name:
CRANBURY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08512-3140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-655-0420
Provider Business Practice Location Address Fax Number:
609-655-8721
Provider Enumeration Date:
10/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
S.
Authorized Official Middle Name:
GEOFFREY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
609-655-0420

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  44SC04609600 , 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)





Copyright © 2007-2025 www.npivalidator.com