1174519037 NPI number — DR. JOHN DOUGLAS ROYALL M.D.

Table of content: DR. JOHN DOUGLAS ROYALL M.D. (NPI 1174519037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174519037 NPI number — DR. JOHN DOUGLAS ROYALL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROYALL
Provider First Name:
JOHN
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
DR.
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:
1174519037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 AVE OF TWO RIVERS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUMSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07760-1802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-747-0591
Provider Business Mailing Address Fax Number:
732-747-8343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 AVE OF TWO RIVERS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUMSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07760-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-747-0591
Provider Business Practice Location Address Fax Number:
732-747-8343
Provider Enumeration Date:
09/26/2005

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: 174400000X , with the licence number:  25MA03272600 , 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: 2223150101 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 855366 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: OK1596 . This is a "PHYSICANS HEALTH SERVICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: J007490 . This is a "TRICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2097550 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 222315102002 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 222315102 . This is a "HORIZON BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2990202 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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