1437141348 NPI number — EASTERN PINES LLC

Table of content: (NPI 1013215466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437141348 NPI number — EASTERN PINES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN PINES 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:
1437141348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 PENSION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLISHTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07726-8400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-446-1804
Provider Business Mailing Address Fax Number:
732-446-0999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 N VERMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTIC CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08401-5561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-344-8900
Provider Business Practice Location Address Fax Number:
609-344-8914
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDMAN
Authorized Official First Name:
BETH
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
732-446-1804

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4462106 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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