1710956370 NPI number — CUMBERLAND NEPHROLOGY ASSOCIATES

Table of content: (NPI 1710956370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710956370 NPI number — CUMBERLAND NEPHROLOGY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMBERLAND NEPHROLOGY ASSOCIATES
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:
1710956370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/24/2017
NPI Reactivation Date:
02/20/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1318 S MAIN RD
Provider Second Line Business Mailing Address:
BUILDING #3
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08360-6516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-205-9900
Provider Business Mailing Address Fax Number:
856-205-0041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1318 S MAIN RD
Provider Second Line Business Practice Location Address:
BUILDING #3
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360-6516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-205-9900
Provider Business Practice Location Address Fax Number:
856-205-0041
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAMICO
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
856-205-9900

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110035388 . This is a "AARP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 360907 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1012159 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5414616 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 360907 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7583702 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0685688000 . This is a "AMERIHEALTH HMO" identifier . This identifiers is of the category "OTHER".




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