1508200569 NPI number — MR. GREGORY GEORGE DIX JR. RPH

Table of content: MR. GREGORY GEORGE DIX JR. RPH (NPI 1508200569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508200569 NPI number — MR. GREGORY GEORGE DIX JR. RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIX
Provider First Name:
GREGORY
Provider Middle Name:
GEORGE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
RPH
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:
1508200569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 STUYVESANT AVE
Provider Second Line Business Mailing Address:
ATTN: RUTGERS UCHC C/O NJDOC
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-292-4036
Provider Business Mailing Address Fax Number:
609-341-9380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 STUYVESANT AVE PO BOX 863
Provider Second Line Business Practice Location Address:
RUTGERS UCHC C/O NJDOC
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-292-4036
Provider Business Practice Location Address Fax Number:
609-341-9380
Provider Enumeration Date:
04/22/2013

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: 183500000X , with the licence number:  28RI02716100 , 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: 28RI02716100 . This is a "RPH LICENSE FOR NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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