1881615771 NPI number — CASTLEROCK, INC

Table of content: REVA SHELAINE MICHAEL BSN, TCRN, PARAMEDIC (NPI 1902789373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881615771 NPI number — CASTLEROCK, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASTLEROCK, INC
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:
1881615771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 E NEW YORK AVE
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
SOMERS POINT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08244-2367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-926-2021
Provider Business Mailing Address Fax Number:
609-926-2022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 E NEW YORK AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SOMERS POINT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08244-2367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-926-2021
Provider Business Practice Location Address Fax Number:
609-926-2022
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOWD
Authorized Official First Name:
M.
Authorized Official Middle Name:
KATHERINE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
609-926-2021

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  25MA04583300 , 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: 0149900 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 043831 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 043831 . This is a "PENNSYLVANIA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0068756 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0368867000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0149900 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: F15687 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P412960 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 060042448 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NJ0015032 . This is a "TRICARE HEALTHNET FEDERAL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1086125 . This is a "LOCAL 825 OPERATING ENGIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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