1144269440 NPI number — JEFFREY WHITWORTH M.D.

Table of content: JEFFREY WHITWORTH M.D. (NPI 1144269440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144269440 NPI number — JEFFREY WHITWORTH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITWORTH
Provider First Name:
JEFFREY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1144269440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1031 MCBRIDE AVE
Provider Second Line Business Mailing Address:
SUITE D203
Provider Business Mailing Address City Name:
WEST PATERSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07424-2559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-256-6350
Provider Business Mailing Address Fax Number:
973-256-7388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1031 MCBRIDE AVE
Provider Second Line Business Practice Location Address:
SUITE D203
Provider Business Practice Location Address City Name:
WEST PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07424-2559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-256-6350
Provider Business Practice Location Address Fax Number:
973-256-7388
Provider Enumeration Date:
06/05/2006

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: 207ND0101X , with the licence number:  MA063604 , 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: 223812197 . This is a "HORIZON BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60000896 . This is a "MHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2145328 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0376198000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31686 . This is a "UNIVERSITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2K3839 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2299410 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8050708 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2881489 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91000267201 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".




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