1508803685 NPI number — BOROUGH OF SPOTSWOOD

Table of content: (NPI 1508803685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508803685 NPI number — BOROUGH OF SPOTSWOOD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOROUGH OF SPOTSWOOD
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:
1508803685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 CENTER STREET
Provider Second Line Business Mailing Address:
PO BOX 274
Provider Business Mailing Address City Name:
SEWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-723-4494
Provider Business Mailing Address Fax Number:
888-449-6833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 SUMMERHILL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOTSWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-251-0700
Provider Business Practice Location Address Fax Number:
732-251-1359
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SERVIS
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
732-251-0700

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0099881 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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