1891779625 NPI number — THE VAN OST INSTITUTE FOR FAMILY LIVING

Table of content: DR. DOMENICK THOMAS ZERO DDS (NPI 1073647723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891779625 NPI number — THE VAN OST INSTITUTE FOR FAMILY LIVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE VAN OST INSTITUTE FOR FAMILY LIVING
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:
1891779625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 E PALISADE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07631-3013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-569-6667
Provider Business Mailing Address Fax Number:
201-569-7504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 E PALISADE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-569-6667
Provider Business Practice Location Address Fax Number:
201-569-7504
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CARLOS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
201-569-6667

Provider Taxonomy Codes

  • Taxonomy code: 2084A0401X , with the licence number:  22295 , 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: 7734204 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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