1114053071 NPI number — YVAN DUCHEINE MD PC

Table of content: (NPI 1114053071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114053071 NPI number — YVAN DUCHEINE MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YVAN DUCHEINE MD PC
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:
1114053071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 MAIN ST STE 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07050-3700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-674-4042
Provider Business Mailing Address Fax Number:
973-674-5070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 MAIN ST STE 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07050-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-674-4042
Provider Business Practice Location Address Fax Number:
973-674-5070
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUCHEINE
Authorized Official First Name:
YVAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-674-4042

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  25MA06289400 , 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: 01077777600 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 549989 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 72L61 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1059165 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 721611 . This is a "WELLCHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: J13132 . This is a "ACS HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 21188 . This is a "UNIVERSITY HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 000953156 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 020041849 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0101394 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7188005 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P856821 . This is a "OXFORDHEALTH INC." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 15603 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1385908 . This is a "UNITED HEALTHCARE INS." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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