1538384425 NPI number — CENTRAL JERSEY INFECTIOUS DISEASES, PC

Table of content: (NPI 1538384425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538384425 NPI number — CENTRAL JERSEY INFECTIOUS DISEASES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL JERSEY INFECTIOUS DISEASES, 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:
1538384425
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:
215 GORDONS CORNER RD STE 2J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANALAPAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07726-3352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-792-0741
Provider Business Mailing Address Fax Number:
732-792-0745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 GORDONS CORNER RD STE 2J
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANALAPAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07726-3352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-792-0741
Provider Business Practice Location Address Fax Number:
732-792-0745
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DELUCA
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT CJID, PC
Authorized Official Telephone Number:
732-792-0741

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  25MA04894600 , 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: 1265523021 . This is a "NPI (INDIVIDUAL)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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