1356368492 NPI number — DR. EROL VEZNEDAROGLU M.D.

Table of content: (NPI 1487058400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356368492 NPI number — DR. EROL VEZNEDAROGLU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VEZNEDAROGLU
Provider First Name:
EROL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1356368492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL CENTER BLVD STE 232
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19013-3902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-464-6387
Provider Business Mailing Address Fax Number:
215-239-3037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 PRINCETON PIKE # 3
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08648-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-464-6387
Provider Business Practice Location Address Fax Number:
215-239-3037
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  MD-066797-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 25MA08474500 , 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: 0018975620001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8857601 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01058155 . This is a "NJ RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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