1760849418 NPI number — DR. JOSEPH PETER CIVITELLO DDS

Table of content: DR. JOSEPH PETER CIVITELLO DDS (NPI 1760849418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760849418 NPI number — DR. JOSEPH PETER CIVITELLO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIVITELLO
Provider First Name:
JOSEPH
Provider Middle Name:
PETER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1760849418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 CARR PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOTOWA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07512-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
862-684-2041
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BAY AVE # 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07042-4837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-429-6887
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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