1497809909 NPI number — DR. MANUEL B NIGALAN M.D.

Table of content: DR. MANUEL B NIGALAN M.D. (NPI 1497809909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497809909 NPI number — DR. MANUEL B NIGALAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIGALAN
Provider First Name:
MANUEL
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1497809909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 WHITE HORSE PIKE
Provider Second Line Business Mailing Address:
SUITE F-4
Provider Business Mailing Address City Name:
ABSECON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08201-1468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-407-6800
Provider Business Mailing Address Fax Number:
609-646-7247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 S NEW YORK AVE
Provider Second Line Business Practice Location Address:
SUITE 512
Provider Business Practice Location Address City Name:
ATLANTIC CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08401-8012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-348-2211
Provider Business Practice Location Address Fax Number:
609-348-2264
Provider Enumeration Date:
01/22/2007

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: 207P00000X , with the licence number:  MA28438 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MA28438 , 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: 4470933 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P0018880 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1056681 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0108724000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2198703 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47733 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60018880 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 30032150 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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