1366405524 NPI number — JASEN LANGLEY DPM

Table of content: JASEN LANGLEY DPM (NPI 1366405524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366405524 NPI number — JASEN LANGLEY DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGLEY
Provider First Name:
JASEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1366405524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4645 HIGHWAY 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07731-3324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-905-1110
Provider Business Mailing Address Fax Number:
732-905-7885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4645 HWY 9 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07731-3354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-905-1110
Provider Business Practice Location Address Fax Number:
732-905-7885
Provider Enumeration Date:
04/10/2006

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: 213E00000X , with the licence number:  MD002717 , 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: 2420480000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K8197 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9112502 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2810436 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000709901 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com