1265592760 NPI number — BETTER MEDICAL GROUP LLC

Table of content: (NPI 1265592760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265592760 NPI number — BETTER MEDICAL GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETTER MEDICAL GROUP 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:
6
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:
1265592760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
179 US HIGHWAY 46 STE 9
Provider Second Line Business Mailing Address:
313
Provider Business Mailing Address City Name:
ROCKAWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07866-4046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-586-4800
Provider Business Mailing Address Fax Number:
888-262-7781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 US HIGHWAY 46 STE 9
Provider Second Line Business Practice Location Address:
313
Provider Business Practice Location Address City Name:
ROCKAWAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07866-4046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-586-4800
Provider Business Practice Location Address Fax Number:
973-586-3559
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANDANAS
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-586-4800

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA00655700 , 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)





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