1245239490 NPI number — ALICIA C SKARIMBAS MD

Table of content: ALICIA C SKARIMBAS MD (NPI 1245239490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245239490 NPI number — ALICIA C SKARIMBAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKARIMBAS
Provider First Name:
ALICIA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1245239490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
370 GRAND AVE STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07631-4109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-567-3370
Provider Business Mailing Address Fax Number:
201-816-1265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631-4154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-567-3370
Provider Business Practice Location Address Fax Number:
201-816-1265
Provider Enumeration Date:
07/19/2005

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: 207Q00000X , with the licence number:  25MA07489600 , 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: 3269 . This is a "MVP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 710555 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 02632415 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000028988 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34828 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J27848 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2081491 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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