1083713853 NPI number — DR. HERVEY SILAS SICHERMAN MD

Table of content: (NPI 1356764732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083713853 NPI number — DR. HERVEY SILAS SICHERMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SICHERMAN
Provider First Name:
HERVEY
Provider Middle Name:
SILAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1083713853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1777 HAMBURG TPKE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-839-5700
Provider Business Mailing Address Fax Number:
973-616-4343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1777 HAMBURG TPKE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-839-5700
Provider Business Practice Location Address Fax Number:
973-616-4343
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  25MA02593900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: MA025939 , 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: 1074689 . This is a "HORIZON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9661480 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4159 . This is a "LOCAL 825" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223338995 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: PS166 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0504225 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 110340 . This is a "BEECHSTREET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 578951 . This is a "EMPIRE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 71602001 . This is a "ONE HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 746693 . This is a "FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 10316586 . This is a "MAGNACARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1074689 . This is a "ANTHEM" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 20019245 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22011051 . This is a "ECS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4159 . This is a "OPERATING LOCAK" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 077148403 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0K0489 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 967203 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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