1366635765 NPI number — DAVID F HEADLEY MD 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 1366635765 NPI number — DAVID F HEADLEY MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID F HEADLEY MD 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:
1366635765
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
737 MAIN ST STE 4
Provider Second Line Business Mailing Address:
TOWER MEDICAL BUILDING
Provider Business Mailing Address City Name:
LUMBERTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08048-3089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-267-7370
Provider Business Mailing Address Fax Number:
609-261-6715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
737 MAIN ST STE 4
Provider Second Line Business Practice Location Address:
TOWER MEDICAL BUILDING
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08048-3089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-267-7370
Provider Business Practice Location Address Fax Number:
609-261-6715
Provider Enumeration Date:
08/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HEADLEY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
609-267-7370

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , 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)





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