1508989526 NPI number — HEALTH GUARD

Table of content: (NPI 1508989526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508989526 NPI number — HEALTH GUARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH GUARD
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:
1508989526
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:
34 ALPINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07751-1276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-617-9251
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
646 STATE ROUTE 18 BLDG B STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08816-3722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-254-9155
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
IZRAILOV
Authorized Official First Name:
VALERIY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OF THE COMPANY
Authorized Official Telephone Number:
732-254-9155

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  7356901 , 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: 7356901 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com