1730355678 NPI number — SUSSEX PULMONARY AND ENDOCRINE CONSULTANTS, PA

Table of content: (NPI 1730355678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730355678 NPI number — SUSSEX PULMONARY AND ENDOCRINE CONSULTANTS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSSEX PULMONARY AND ENDOCRINE CONSULTANTS, 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:
1730355678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21505 WILLOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-6034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-947-4507
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18947 JOHN J WILLIAMS HWY UNIT 305
Provider Second Line Business Practice Location Address:
BEEBE HEALTH CAMPUS, MEDICAL ARTS CENTER
Provider Business Practice Location Address City Name:
REHOBOTH BEACH
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19971-4477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-644-7201
Provider Business Practice Location Address Fax Number:
302-644-7218
Provider Enumeration Date:
04/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SINGH
Authorized Official First Name:
REETU
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
302-249-9970

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  C10006856 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: C10006874 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: C10006856 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: C10006856 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000035976 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".