1649339060 NPI number — DR. FRANK BENJAMIN CANCELLIERI DDS

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 1649339060 NPI number — DR. FRANK BENJAMIN CANCELLIERI DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANCELLIERI
Provider First Name:
FRANK
Provider Middle Name:
BENJAMIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1649339060
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:
861 COLTS NECK ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEHOLD TWP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-8108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-431-5678
Provider Business Mailing Address Fax Number:
732-431-5678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BOX 866 RANGE RD
Provider Second Line Business Practice Location Address:
MID STATE CORRECTIONAL FACILITY CMS MEDICAL
Provider Business Practice Location Address City Name:
WRIGHTSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-724-9139
Provider Business Practice Location Address Fax Number:
609-724-9124
Provider Enumeration Date:
12/08/2006

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: 122300000X , with the licence number:  22D100875200 , 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)





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