1356864573 NPI number — WINDMILL ALLIANCE INC.

Table of content: (NPI 1356864573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356864573 NPI number — WINDMILL ALLIANCE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDMILL ALLIANCE 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:
1356864573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYONNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07002-2459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-858-4460
Provider Business Mailing Address Fax Number:
201-443-2427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 BROADWAY APT 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYONNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07002-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-858-4460
Provider Business Practice Location Address Fax Number:
201-443-2429
Provider Enumeration Date:
07/19/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TASSONE-DOST
Authorized Official First Name:
JOANN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
ASSISTANT EXECUTIVE DIRECTOR, WMA
Authorized Official Telephone Number:
201-858-4460

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  SA1320 , 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)