1114265006 NPI number — PACILIO CHIROPRACTIC ASSOCIATES LLC

Table of content: (NPI 1114265006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114265006 NPI number — PACILIO CHIROPRACTIC ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACILIO CHIROPRACTIC ASSOCIATES 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:
1114265006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 N BLACK HORSE PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUNNEMEDE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08078-1320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-939-6196
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 N BLACK HORSE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUNNEMEDE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08078-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-939-6196
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PACILIO
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-939-6196

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00579400 , 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: 0696713000 . This is a "AMERIHEALTH PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 072288 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2271828000 . This is a "AMERIHEALTH GROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3118812 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3480975 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00058776 . This is a "RAILROAD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com