1427552231 NPI number — CARNEGIE HEALTHCARE CORP

Table of content: DR. DALE ERSKINE BOLT DMD (NPI 1891702866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427552231 NPI number — CARNEGIE HEALTHCARE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARNEGIE HEALTHCARE CORP
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:
1427552231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 TEXAS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08648-3709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-530-1800
Provider Business Mailing Address Fax Number:
609-530-9800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 TEXAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08648-3709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-530-1800
Provider Business Practice Location Address Fax Number:
609-530-9800
Provider Enumeration Date:
03/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
JUNEJA
Authorized Official First Name:
SATISH
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
609-530-1800

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1117698 . This is a "HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0493716 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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