1457349177 NPI number — JOHN HWANG

Table of content: JOHN HWANG (NPI 1457349177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457349177 NPI number — JOHN HWANG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HWANG
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1457349177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRINGTON PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07640-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-784-0123
Provider Business Mailing Address Fax Number:
201-784-0065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRINGTON PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07640-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-784-0123
Provider Business Practice Location Address Fax Number:
201-784-0065
Provider Enumeration Date:
10/06/2005

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: 207R00000X , with the licence number:  25MA06561200 , 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: 1K2581 . This is a "HEALTHNET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223413838 . This is a "TAX IDENTIFICATION #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P922845 . This is a "OXFORD #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2145219 . This is a "AETNA HMO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 29N251 . This is a "EMPIRE #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8149402 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5847705 . This is a "AETNA PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2330926000 . This is a "AMERIHEALTH #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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