1750309589 NPI number — SUDHIR M PARIKH M D P A

Table of content: (NPI 1750309589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750309589 NPI number — SUDHIR M PARIKH M D P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUDHIR M PARIKH M D P A
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:
1750309589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 N 3RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08904-2408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-545-0094
Provider Business Mailing Address Fax Number:
732-545-4087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 N 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08904-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-545-0094
Provider Business Practice Location Address Fax Number:
732-545-4087
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARIKH
Authorized Official First Name:
SUDHIR
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER OF CORPORATION
Authorized Official Telephone Number:
732-545-0094

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0150142000 . This is a "KEYSTONE HEALTHPLAN EAST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2235111 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2235107 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8828709 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000K01280 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0150142000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1111081 . This is a "HORIZON HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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