1194764324 NPI number — JOHN S OWENS MD

Table of content: JOHN S OWENS MD (NPI 1194764324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194764324 NPI number — JOHN S OWENS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OWENS
Provider First Name:
JOHN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1194764324
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 W RED BANK AVE
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08096-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-845-6807
Provider Business Mailing Address Fax Number:
856-845-3760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 W RED BANK AVE
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08096-1630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-845-6807
Provider Business Practice Location Address Fax Number:
856-845-3760
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: 207RC0000X , with the licence number:  MA28117 , 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: P499317 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1684507 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33422 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0080962000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 118024 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0080962000 . This is a "PENNSYLVANIA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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