1710077128 NPI number — MR. BRUCE E REIM MSW

Table of content: MR. BRUCE E REIM MSW (NPI 1710077128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710077128 NPI number — MR. BRUCE E REIM MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REIM
Provider First Name:
BRUCE
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1710077128
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:
204 HOLLOW ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKILLMAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08558-1409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-466-0166
Provider Business Mailing Address Fax Number:
609-466-0166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 HOLLOW ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKILLMAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08558-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-466-0166
Provider Business Practice Location Address Fax Number:
609-466-0166
Provider Enumeration Date:
10/14/2006

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: 103T00000X , with the licence number:  44SC00178700 , 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: 051775 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7328354 . This is a "GHI" identifier . This identifiers is of the category "OTHER".




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