1508939422 NPI number — DUBIN CHIROPRACTIC CENTER PC

Table of content: (NPI 1508939422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508939422 NPI number — DUBIN CHIROPRACTIC CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUBIN CHIROPRACTIC CENTER PC
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:
1508939422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29-15 FAIR LAWN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIR LAWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07410-3412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-794-6260
Provider Business Mailing Address Fax Number:
201-794-1985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29-15 FAIR LAWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIR LAWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07410-3412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-794-6260
Provider Business Practice Location Address Fax Number:
201-794-1985
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUBIN
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-794-6260

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2423 , 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: 1013532 . This is a "AMERICAN SPECIALTY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 582363 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 99904 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 050002423NJ01 . This is a "ANTHEM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0935265 . This is a "AETNA HMO POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1389408 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32343 . This is a "MASTERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: X5254 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4358342 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: X5254 . This is a "WELLCHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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