1922066935 NPI number — CENTRAL JERSEY PULMONARY MEDICINE

Table of content: (NPI 1922066935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922066935 NPI number — CENTRAL JERSEY PULMONARY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL JERSEY PULMONARY MEDICINE
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:
1922066935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 284
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICKATUNK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-264-7755
Provider Business Mailing Address Fax Number:
732-264-8858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 N BEERS ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
HOLMDEL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07733-1520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-264-7755
Provider Business Practice Location Address Fax Number:
732-264-8858
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AGGARWAL
Authorized Official First Name:
VINOD
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-264-7755

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CH4754 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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