1629145115 NPI number — JOHN R WITTENBORN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629145115 NPI number — JOHN R WITTENBORN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WITTENBORN
Provider First Name:
JOHN
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:
1629145115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 363
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERNARDSVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07924-0363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-696-8940
Provider Business Mailing Address Fax Number:
609-261-7199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 UNION AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BRIDGEWATER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08807-3063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-261-5755
Provider Business Practice Location Address Fax Number:
609-261-7199
Provider Enumeration Date:
11/29/2006

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: 207T00000X , with the licence number:  MA070083 , 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: 669902 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0231523000 . This is a "AMERIHEALTH KEYSTONE PC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1161130 . This is a "MECY HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2336458 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2052026 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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