1417188905 NPI number — HUMC CARDIOVASCULAR PARTNERS, PC

Table of content: (NPI 1417188905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417188905 NPI number — HUMC CARDIOVASCULAR PARTNERS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMC CARDIOVASCULAR PARTNERS, PC
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:
1417188905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 PROSPECT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HACKENSACK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07601-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-336-8406
Provider Business Mailing Address Fax Number:
201-343-9823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 FRANK W. BURR BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 22
Provider Business Practice Location Address City Name:
TEANECK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07666-6700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-907-0442
Provider Business Practice Location Address Fax Number:
201-692-3263
Provider Enumeration Date:
07/31/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EMERSON
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PROFESSIONAL SERVICES
Authorized Official Telephone Number:
201-996-5633

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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