1720287550 NPI number — PHYSICIANS HOME & HEALTH SERVICES

Table of content: WILLIAM PRYOR CROOKS MD (NPI 1598879314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720287550 NPI number — PHYSICIANS HOME & HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS HOME & HEALTH SERVICES
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:
1720287550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 518
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEPTUNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07754-0518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-775-8400
Provider Business Mailing Address Fax Number:
732-775-8401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1532 CORLIES AVE
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-4904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-775-8400
Provider Business Practice Location Address Fax Number:
732-775-8401
Provider Enumeration Date:
07/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROPER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-775-8400

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA06388400 , 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)





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