1225034887 NPI number — SAMUEL CARUTHERS M.D.

Table of content: SAMUEL CARUTHERS M.D. (NPI 1225034887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225034887 NPI number — SAMUEL CARUTHERS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARUTHERS
Provider First Name:
SAMUEL
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:
1225034887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN LAKES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07046-1119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
862-222-4629
Provider Business Mailing Address Fax Number:
973-352-9519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 MAIN ST STE 101D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOONTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07005-1799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
862-222-4629
Provider Business Practice Location Address Fax Number:
973-352-9519
Provider Enumeration Date:
06/28/2005

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: 207L00000X , with the licence number:  217213 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 25MA07863200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 217213 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 25MA07863200 , 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: 402459100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".