1417177791 NPI number — OVERLOOK HOSPITAL

Table of content: (NPI 1417177791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417177791 NPI number — OVERLOOK HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OVERLOOK HOSPITAL
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:
1417177791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
736 COOLIDGE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-654-7098
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 BEAUVOIR AVENUE
Provider Second Line Business Practice Location Address:
CARDIAC REHAB, 1ST FLOOR
Provider Business Practice Location Address City Name:
SUMMIT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-522-2833
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUSCH
Authorized Official First Name:
DARLENE
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
DIETITIAN
Authorized Official Telephone Number:
908-522-2833

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  724232 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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