1508316555 NPI number — THE NEW VILLAGE VIEW SP LLC

Table of content: (NPI 1508316555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508316555 NPI number — THE NEW VILLAGE VIEW SP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE NEW VILLAGE VIEW SP LLC
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:
1508316555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 WHISPERING PINES LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-1421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12528-1339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-691-8399
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHONBERGER
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
732-363-7770

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  740-F-084 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04338198 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".