1245285121 NPI number — GARY X. HECK & RONALD L. SCHIAVONE, LLC

Table of content: (NPI 1245285121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245285121 NPI number — GARY X. HECK & RONALD L. SCHIAVONE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARY X. HECK & RONALD L. SCHIAVONE, LLC
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:
1245285121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 GIBBSBORO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEMENTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08021-4132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-784-4999
Provider Business Mailing Address Fax Number:
856-784-0258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 GIBBSBORO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEMENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08021-4132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-784-4999
Provider Business Practice Location Address Fax Number:
856-784-0258
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HECK
Authorized Official First Name:
JEANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
856-751-6403

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000458806 . This is a "HIGHMARK BLUE SHIELD ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0121648002 . This is a "AMERIHEALTH HMO -OFFICE 2" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0121648001 . This is a "HMO AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3533107 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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