1376545897 NPI number — ERIC MARGOLIS

Table of content: ERIC MARGOLIS (NPI 1376545897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376545897 NPI number — ERIC MARGOLIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARGOLIS
Provider First Name:
ERIC
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1376545897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 DIAMOND HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY HEIGHTS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07922-2104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-273-4300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
663 PALISADE AVE STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFFSIDE PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07010-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-313-1933
Provider Business Practice Location Address Fax Number:
201-313-9599
Provider Enumeration Date:
08/15/2005

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: 208800000X , with the licence number:  25MA06410400 , 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: 53T591 . This is a "EMPIRE BC/BS (ENGLEWOOD)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P406621 . This is a "OXFORD #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2356155 . This is a "AETNA HMO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 340015151 . This is a "RAILROAD MDCR #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 53T592 . This is a "EMPIRE BC/BS (CLIFFSIDE)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0990766000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5290504 . This is a "AETNA PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7005008 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0K7855 . This is a "HEALTHNET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1099196 . This is a "GHI PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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