1972713683 NPI number — JEREMY AIKEY D.O.

Table of content: JEREMY AIKEY D.O. (NPI 1972713683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972713683 NPI number — JEREMY AIKEY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AIKEY
Provider First Name:
JEREMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1972713683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4423 ROUTE 130 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08016-2385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-386-0202
Provider Business Mailing Address Fax Number:
609-386-5927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2630 WESTVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19610-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-376-1981
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2007

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: 207W00000X , with the licence number:  OS015106 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: TEMPORARY/PENDING # , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0107X , with the licence number: OS015106 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 25MB09214800 , 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: 0402362 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102468851 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".