1922210806 NPI number — MARTIN WHITEMAN D.O. P.A.

Table of content: (NPI 1922210806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922210806 NPI number — MARTIN WHITEMAN D.O. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN WHITEMAN D.O. P.A.
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:
1922210806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 326
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN LAKES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07417-0326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-606-4754
Provider Business Mailing Address Fax Number:
201-847-0059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 FALLING OAKS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08753-8408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-606-4754
Provider Business Practice Location Address Fax Number:
201-847-0059
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITEMAN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
732-606-4754

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MA59181 , 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: 5458102 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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