1841738010 NPI number — BURCHELL ADVANCED PRACTICE SERVICES

Table of content: NICHOLAS PEREZ D.M.D (NPI 1366127078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841738010 NPI number — BURCHELL ADVANCED PRACTICE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURCHELL ADVANCED PRACTICE SERVICES
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:
1841738010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 CLAIRMONT DR
Provider Second Line Business Mailing Address:
SUITE L7
Provider Business Mailing Address City Name:
WOODCLIFF LAKE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07677-7635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-248-5643
Provider Business Mailing Address Fax Number:
201-664-3050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
978 ROUTE 45
Provider Second Line Business Practice Location Address:
SUITE L7
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10970-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-248-5643
Provider Business Practice Location Address Fax Number:
201-664-3050
Provider Enumeration Date:
02/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BURCHELL
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
201-248-5643

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F333129-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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