1316457526 NPI number — THE ARC OF MONMOUTH, INC

Table of content: (NPI 1316457526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316457526 NPI number — THE ARC OF MONMOUTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ARC OF MONMOUTH, 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:
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:
1316457526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1158 WAYSIDE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TINTON FALLS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-493-1919
Provider Business Mailing Address Fax Number:
732-493-3604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 WAYSIDE ROAD APT 110
Provider Second Line Business Practice Location Address:
WAYSIDE OAKS
Provider Business Practice Location Address City Name:
TINTON FALLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-686-1520
Provider Business Practice Location Address Fax Number:
732-686-1571
Provider Enumeration Date:
10/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ANGEL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
732-493-1919

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  SA2137 , 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: 0462985 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com