1932499266 NPI number — DR. JEFFREY MICHAEL KORNITZER M.D.

Table of content: DR. JEFFREY MICHAEL KORNITZER M.D. (NPI 1932499266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932499266 NPI number — DR. JEFFREY MICHAEL KORNITZER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORNITZER
Provider First Name:
JEFFREY
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1932499266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 BERGEN ST
Provider Second Line Business Mailing Address:
SUITE 8100
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07103-2425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-972-7151
Provider Business Mailing Address Fax Number:
973-972-9960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 BERGEN ST STE 8100
Provider Second Line Business Practice Location Address:
ROOM F-603
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-7151
Provider Business Practice Location Address Fax Number:
973-972-1019
Provider Enumeration Date:
04/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0402X , with the licence number:  25MA09571600 , 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)





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