1316044696 NPI number — MONTCLAIR EMERGENCY MEDICAL ASSOCIATES

Table of content: DR. CORRADO JOHN ALTOMARE MD (NPI 1275707663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316044696 NPI number — MONTCLAIR EMERGENCY MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTCLAIR EMERGENCY MEDICAL ASSOCIATES
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:
1316044696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 80456
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CITY OF INDUSTRY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91716-8402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-379-2134
Provider Business Mailing Address Fax Number:
310-379-4856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 SAN BERNARDINO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91763-2326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-625-8307
Provider Business Practice Location Address Fax Number:
909-625-8255
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUEVARA
Authorized Official First Name:
JUSTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPARTMENT COORDINATOR
Authorized Official Telephone Number:
424-241-1546

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0104390 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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