1245250612 NPI number — STEPHEN R NOONE D.P.M.

Table of content: STEPHEN R NOONE D.P.M. (NPI 1245250612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245250612 NPI number — STEPHEN R NOONE D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOONE
Provider First Name:
STEPHEN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1245250612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52 BERLIN RD
Provider Second Line Business Mailing Address:
SUITE 5000
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08034-3573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-795-1003
Provider Business Mailing Address Fax Number:
856-795-5994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 BERLIN RD
Provider Second Line Business Practice Location Address:
SUITE 5000
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08034-3573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-795-1003
Provider Business Practice Location Address Fax Number:
856-795-5994
Provider Enumeration Date:
07/20/2006

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: 213E00000X , with the licence number:  25MD00265900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: SC004617L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01868201 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8691207 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60984 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9209717 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2532063 . This is a "OXFORD INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 214416500 . This is a "KEYSTONE HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1459159 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01000755800 . This is a "AMERICHOICE OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00152413 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0283477 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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