1952320244 NPI number — WEST ORANGE MEDICAL ASSOCIATES PC

Table of content: (NPI 1952320244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952320244 NPI number — WEST ORANGE MEDICAL ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST ORANGE MEDICAL ASSOCIATES PC
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:
1952320244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT JERVIS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12771-0243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-649-3863
Provider Business Mailing Address Fax Number:
845-856-5439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 WHEATFIELD DR
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18337-7697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-294-4350
Provider Business Practice Location Address Fax Number:
845-294-4333
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
845-649-3864

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  33086 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: MD061877L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 206842 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: WE622951 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CN5462 . This is a "RR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 045622PN3 . This is a "PA MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018601600004 . This is a "MEDICAID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02161270 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7856407 . This is a "NJ MEDICAID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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