1134165392 NPI number — JOHN W DIERING OD

Table of content: JOHN W DIERING OD (NPI 1134165392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134165392 NPI number — JOHN W DIERING OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIERING
Provider First Name:
JOHN
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1134165392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 ROUTE 168
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TURNERSVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08012-3233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-227-0720
Provider Business Mailing Address Fax Number:
856-227-8550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 ROUTE 168
Provider Second Line Business Practice Location Address:
SUITE E5
Provider Business Practice Location Address City Name:
TURNERSVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08012-3233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-227-0720
Provider Business Practice Location Address Fax Number:
856-227-8550
Provider Enumeration Date:
06/22/2006

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: 152WV0400X , with the licence number:  04944 , 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: 0921403005 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 571436 . This is a "FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223048927 . This is a "BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 410026820 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0426060000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223713 . This is a "US FAMILY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 91001904200 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1535501 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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