1881937381 NPI number — INFECTIOUS DISEASE PHYSICIANS,PA

Table of content: (NPI 1881937381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881937381 NPI number — INFECTIOUS DISEASE PHYSICIANS,PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFECTIOUS DISEASE PHYSICIANS,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:
1881937381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 BRIGGS RD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
MOUNT LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-4100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-866-7466
Provider Business Mailing Address Fax Number:
856-866-9088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 ROUTE 73
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-9611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-866-7466
Provider Business Practice Location Address Fax Number:
856-866-9088
Provider Enumeration Date:
04/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TOPIEL
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-866-7466

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  25MA09219700 , 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: 5100101 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com