1831106558 NPI number — KAMAL GREISS MD PA

Table of content: STEPHANIE SCANTLEN GARDNER LCSW (NPI 1730316878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831106558 NPI number — KAMAL GREISS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAMAL GREISS MD 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:
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:
1831106558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 BREWSTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYCKOFF
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07481-2156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-451-1441
Provider Business Mailing Address Fax Number:
201-451-1088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 MONTGOMERY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-451-1441
Provider Business Practice Location Address Fax Number:
201-451-1088
Provider Enumeration Date:
08/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREISS
Authorized Official First Name:
KAMAL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
201-451-1441

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  FACILITY80238 , 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: 2893207 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013442 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0788531000 . This is a "AMERIHEALTH GROUP" identifier . This identifiers is of the category "OTHER".