1053392258 NPI number — SCOTT W SILODOR M.D.

Table of content: SCOTT W SILODOR M.D. (NPI 1053392258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053392258 NPI number — SCOTT W SILODOR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILODOR
Provider First Name:
SCOTT
Provider Middle Name:
W
Provider Name Prefix Text:
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:
1053392258
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 HAMBURG TPKE
Provider Second Line Business Mailing Address:
224
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07470-5043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-696-0998
Provider Business Mailing Address Fax Number:
973-696-3247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 HAMBURG TPKE
Provider Second Line Business Practice Location Address:
224
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470-5043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-696-0998
Provider Business Practice Location Address Fax Number:
973-696-3247
Provider Enumeration Date:
11/07/2005

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:  25MA06061500 , 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: 191754 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2026619 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149689AWS . This is a "MEDICARE RENDERING NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P1603435 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 037893 . This is a "MEDICARE GROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0497752 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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