1316103781 NPI number — ERICKSON HEALTH MEDICAL GROUP OF NJ PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316103781 NPI number — ERICKSON HEALTH MEDICAL GROUP OF NJ PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERICKSON HEALTH MEDICAL GROUP OF NJ PC
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:
1316103781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5525 RESEARCH PARK DR
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-4664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-402-2258
Provider Business Mailing Address Fax Number:
410-204-7279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 ESSEX RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TINTON FALLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-2631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-643-2070
Provider Business Practice Location Address Fax Number:
732-643-2015
Provider Enumeration Date:
08/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NARRETT
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VP/CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
410-402-2261

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6145940004 . This is a "DME" identifier . This identifiers is of the category "OTHER".




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