1508951740 NPI number — TERRY A PAKISH MD

Table of content: TERRY A PAKISH MD (NPI 1508951740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508951740 NPI number — TERRY A PAKISH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAKISH
Provider First Name:
TERRY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAKISH
Provider Other First Name:
TERRY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508951740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 NORTH OLDEN AVE EXT
Provider Second Line Business Mailing Address:
SUITE 9A
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-883-3444
Provider Business Mailing Address Fax Number:
609-883-6297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 NORTH OLDEN AVE EXT
Provider Second Line Business Practice Location Address:
SUITE 9A
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:
609-883-3444
Provider Business Practice Location Address Fax Number:
609-883-6297
Provider Enumeration Date:
10/04/2006

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: 208D00000X , with the licence number:  MA40233 , 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: 0270857001 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: E08727 . This is a "AMERIHEALTH ADMINISTRATOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223649732 . This is a "HORIZON BLUE CROSS AND BL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 208136 . This is a "UNITED HEALTHCARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1K3854 . This is a "HEALTH NET OF NORTHEAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223649732 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223649732 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4316089 . This is a "AETNA PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 508727 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P2943261 . This is a "OXFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223649732 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53172 . This is a "HIGHMARK BLUE CROSS BLUE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com