1407517386 NPI number — FTX NEW JERSEY LLC

Table of content: (NPI 1407517386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407517386 NPI number — FTX NEW JERSEY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FTX NEW JERSEY 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:
1407517386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7815 NW BEACON SQUARE BLVD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33487-1345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-995-0136
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3817 CROSSWICKS-HAMILTON SQ RD
Provider Second Line Business Practice Location Address:
UNIT G, SUITE 128
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-995-0136
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KHATAMI
Authorized Official First Name:
SEYED
Authorized Official Middle Name:
HESSAM
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
561-995-0136

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)