1366836520 NPI number — GEORGE XENAKIS, DDS, PALISADES PARK, LLC

Table of content: MR. JEFFREY L. JOHNSON CRNA (NPI 1164448494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366836520 NPI number — GEORGE XENAKIS, DDS, PALISADES PARK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE XENAKIS, DDS, PALISADES PARK, LLC
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:
1366836520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
261A BROAD AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALISADES PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-676-3003
Provider Business Mailing Address Fax Number:
201-676-2613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
261A BROAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALISADES PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-676-3003
Provider Business Practice Location Address Fax Number:
201-676-2613
Provider Enumeration Date:
03/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
XENAKIS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
212-643-0927

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  22DI01715600 , 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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