1740261064 NPI number — GALLOPING HILL SURGICAL, LLC

Table of content: (NPI 1740261064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740261064 NPI number — GALLOPING HILL SURGICAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GALLOPING HILL SURGICAL, LLC
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:
1740261064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
593 NASSAU ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08902-2938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-251-8000
Provider Business Mailing Address Fax Number:
866-511-0294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
593 NASSAU ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08902-2938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-251-8000
Provider Business Practice Location Address Fax Number:
866-511-0294
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
WINTHROP
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-244-4660

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 56744 . This is a "NORTHWOOD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6774903 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 565144 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0002632000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: MI0000352 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 47462 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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