1437211323 NPI number — BLOOMINGDALE PODIATRY CENTER, PA

Table of content: (NPI 1437211323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437211323 NPI number — BLOOMINGDALE PODIATRY CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOOMINGDALE PODIATRY CENTER, PA
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:
1437211323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMINGDALE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07403-0015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-838-8885
Provider Business Mailing Address Fax Number:
973-283-1875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 CAREY AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07405-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-838-8885
Provider Business Practice Location Address Fax Number:
973-283-1875
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PALMAROZZO
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-838-8885

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  25MD00175800 , 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: 0827428-004 . This is a "CIGNA ID NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P378132 . This is a "OXFORD HEALH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: F00962 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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