1548238280 NPI number — STEVE R FALLEK MD

Table of content: STEVE R FALLEK MD (NPI 1548238280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548238280 NPI number — STEVE R FALLEK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FALLEK
Provider First Name:
STEVE
Provider Middle Name:
R
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:
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:
1548238280
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 640
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-759-8005
Provider Business Mailing Address Fax Number:
973-759-7545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 SYLVAN AVE
Provider Second Line Business Practice Location Address:
STE 301
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07632-2525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-541-4181
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2006

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: 2086S0122X , with the licence number:  25MA06012100 , 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: 7720505 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com