1669565396 NPI number — JOHANNA JACQUELINE GONZALEZ MEJIA M.D.

Table of content: MARGARET HUNT P.A. (NPI 1770910820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669565396 NPI number — JOHANNA JACQUELINE GONZALEZ MEJIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ MEJIA
Provider First Name:
JOHANNA
Provider Middle Name:
JACQUELINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1669565396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
433 NORTH BROAD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07208-3398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-436-1002
Provider Business Mailing Address Fax Number:
908-436-1109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 NORTH BROAD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07208-3398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-436-1002
Provider Business Practice Location Address Fax Number:
908-436-1109
Provider Enumeration Date:
10/02/2006

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: 174400000X , with the licence number:  25MA06899700 , 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: 202092816 . This is a "TAX ID," identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: AH0236165301 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60013229 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000296602 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 97222 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8565708 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31002 . This is a "UNIVERSITY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7752202 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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