1821044090 NPI number — STEVEN AIGBOGUN RPT

Table of content: STEVEN AIGBOGUN RPT (NPI 1821044090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821044090 NPI number — STEVEN AIGBOGUN RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AIGBOGUN
Provider First Name:
STEVEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT
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:
1821044090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 VILLAGE DR
Provider Second Line Business Mailing Address:
PO BOX 874
Provider Business Mailing Address City Name:
CAPE MAY COURT HOUSE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08210-1939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-463-9553
Provider Business Mailing Address Fax Number:
609-463-9540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE MAY COURT HOUSE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08210-1939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-463-9553
Provider Business Practice Location Address Fax Number:
609-463-9540
Provider Enumeration Date:
05/26/2006

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: 225100000X , with the licence number:  40QA00466300 , 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)

  • Identifier: 223305571 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 650010941 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1347424 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223305571 . This is a "TRICARE / CHAMPUS GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1602579 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P853305 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0822480001 . This is a "DMERC A" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2281152000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: DD2634 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223305571 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223305571 . This is a "HORIZON BLUE SHIELD GRP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223305571 . This is a "HORIZON MERCY HP GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 58001 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1602584 . This is a "AMERIHEALTH HMO GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K3845 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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