1275930752 NPI number — SPRINGPOINT AT MONROE VILLAGE, INC.

Table of content: (NPI 1275930752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275930752 NPI number — SPRINGPOINT AT MONROE VILLAGE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINGPOINT AT MONROE VILLAGE, INC.
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:
MONROE VILLAGE
Provider Other Organization Name Type Code:
3
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:
1275930752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4814 OUTLOOK DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
WALL TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07753-6812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-430-3650
Provider Business Mailing Address Fax Number:
732-430-3711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 DAVID BRAINERD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08831-1927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-521-6407
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MIDGETT
Authorized Official First Name:
GARRETT
Authorized Official Middle Name:
T
Authorized Official Title or Position:
SR. V.P./CFO
Authorized Official Telephone Number:
732-430-3675

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251G0304X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 50A8312 , 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: 0124541 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".