1386619997 NPI number — COMPREHENSIVE ENDOCRINE CARE DIABETES HORMONES AND METABOLISM

Table of content: (NPI 1386619997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386619997 NPI number — COMPREHENSIVE ENDOCRINE CARE DIABETES HORMONES AND METABOLISM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE ENDOCRINE CARE DIABETES HORMONES AND METABOLISM
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:
6
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:
1386619997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 448
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATHAM
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07928-0448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-868-0001
Provider Business Mailing Address Fax Number:
201-868-0999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7800 PALISADE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BERGEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07047-5527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-868-0001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAMACHO
Authorized Official First Name:
EVELYN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-868-0001

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  MA75436 , 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)





Copyright © 2007-2025 www.npivalidator.com