1487253779 NPI number — INTEGRITY, INC

Table of content: (NPI 1487253779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487253779 NPI number — INTEGRITY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRITY, INC
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:
1487253779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/05/2021
NPI Reactivation Date:
06/30/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 LINCOLN PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07102-2388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-623-0600
Provider Business Mailing Address Fax Number:
973-623-2205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1091-1093 BROAD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-623-0600
Provider Business Practice Location Address Fax Number:
973-642-5915
Provider Enumeration Date:
10/19/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WOOTEN
Authorized Official First Name:
SONYA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING SERVICES
Authorized Official Telephone Number:
973-623-0600

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0310221 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2000050 . This is a "STATE LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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