1437146792 NPI number — PAUL WANGENHEIM MD

Table of content: PAUL WANGENHEIM MD (NPI 1437146792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437146792 NPI number — PAUL WANGENHEIM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANGENHEIM
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1437146792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
741 NORTHFIELD AVE
Provider Second Line Business Mailing Address:
STE 205
Provider Business Mailing Address City Name:
WEST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07052-1174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-467-1544
Provider Business Mailing Address Fax Number:
973-467-9586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
741 NORTHFIELD AVE
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
WEST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07052-1174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-467-1544
Provider Business Practice Location Address Fax Number:
973-467-9586
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  43085 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1K9394 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5710574 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1918206 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4116261 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01000350800 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1001644002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: ES229 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81557 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19E881 . This is a "WELLCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0300997000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com