1972706455 NPI number — DAVID M. FENIGER

Table of content: (NPI 1972706455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972706455 NPI number — DAVID M. FENIGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID M. FENIGER
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:
BROADWAY PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1972706455
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1039 AVENUE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYONNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07002-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-437-0313
Provider Business Mailing Address Fax Number:
201-437-3811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1039 AVENUE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYONNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07002-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-437-0313
Provider Business Practice Location Address Fax Number:
201-437-3811
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FENIGER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-437-0313

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  QA03000 , 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: 235288 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0040050 . This is a "ORTHONET (CIGNA)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 123521 . This is a "AETNA HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: ANC840 . This is a "ORTHONET (OXFORD)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0040052 . This is a "ORTHONET (AETNA)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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