1154682680 NPI number — CRITICAL CARE PHYSICIANS OF NEW JERSEY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154682680 NPI number — CRITICAL CARE PHYSICIANS OF NEW JERSEY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRITICAL CARE PHYSICIANS OF NEW JERSEY 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:
1154682680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5410 MARYLAND WAY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-377-5600
Provider Business Mailing Address Fax Number:
888-241-1404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
454 HURFFVILLE CROSS KEYS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TURNERSVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08012-2448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-377-5600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FALL
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
253-682-6040

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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