1710068150 NPI number — CHARLES M CUMMINS OD PA

Table of content: (NPI 1710068150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710068150 NPI number — CHARLES M CUMMINS OD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES M CUMMINS OD PA
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:
6
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:
1710068150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 846338
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-6338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-524-6663
Provider Business Mailing Address Fax Number:
210-524-6587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 ROUTE 66
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-775-0013
Provider Business Practice Location Address Fax Number:
732-775-3513
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUMMINS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-338-8886

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5257603 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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