1275569709 NPI number — GROSSMAN, LEVINE, DIGAETANO

Table of content: (NPI 1275569709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275569709 NPI number — GROSSMAN, LEVINE, DIGAETANO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROSSMAN, LEVINE, DIGAETANO
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:
1275569709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 MADISON AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MOUNT HOLLY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08060-2055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-261-4925
Provider Business Mailing Address Fax Number:
606-261-9362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MOUNT HOLLY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08060-2055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-261-4925
Provider Business Practice Location Address Fax Number:
606-261-9362
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEVINE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
TEDDY
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
609-261-6701

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0135505000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com