1659423549 NPI number — PEMCARE LLC

Table of content: (NPI 1659423549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659423549 NPI number — PEMCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEMCARE LLC
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:
1659423549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
267 CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METUCHEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08840-1269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-287-6004
Provider Business Mailing Address Fax Number:
732-287-3575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
267 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METUCHEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08840-1269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-287-6004
Provider Business Practice Location Address Fax Number:
732-287-3575
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MISKO
Authorized Official First Name:
GARY
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-287-6004

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MA62917 , 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: 1737406 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2596853 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1934612 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40049 . This is a "MEDICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0744764001 . This is a "AMERIHEALTH HMO POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4H8791 . This is a "WELLCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8637489 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0462541000 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1734357 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2185368 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: J7960 . This is a "HORIZON HMO POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1K2138 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23641 . This is a "AETNA CAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31832 . This is a "MASTERCARE" identifier . This identifiers is of the category "OTHER".




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