1174519292 NPI number — CITY OF PATERSON

Table of content: (NPI 1174519292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174519292 NPI number — CITY OF PATERSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF PATERSON
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:
1174519292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 WASHINGTON ST
Provider Second Line Business Mailing Address:
C/O DCM INC
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08753-6855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-240-3030
Provider Business Mailing Address Fax Number:
732-914-0470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07505-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-321-1400
Provider Business Practice Location Address Fax Number:
732-914-0470
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCANELLA
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERNAL SUDITOR
Authorized Official Telephone Number:
973-321-1400

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  N/A , 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: 3467201 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016203000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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