1497793525 NPI number — JAMES A GAETA D.C.

Table of content: JAMES A GAETA D.C. (NPI 1497793525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497793525 NPI number — JAMES A GAETA D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAETA
Provider First Name:
JAMES
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1497793525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 SALEM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08096-3118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-853-7577
Provider Business Mailing Address Fax Number:
856-845-7829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 SALEM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08096-3118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-853-7577
Provider Business Practice Location Address Fax Number:
856-845-7829
Provider Enumeration Date:
06/02/2006

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: 111N00000X , with the licence number:  38MC00506100 , 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: 2663629 . This is a "AETNA ID NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223840810 . This is a "HORIZON BC/BS OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0189253000 . This is a "AMERIHELATH IDNUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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