1467534495 NPI number — RAHWAY PATHOLOGY, P.A.

Table of content: MRS. NANCY GRANTHAM WALKER RN (NPI 1750643623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467534495 NPI number — RAHWAY PATHOLOGY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAHWAY PATHOLOGY, P.A.
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:
1467534495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 WALL ST W STE 360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNDHURST
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07071-3604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
865 STONE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAHWAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07065-2742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-499-6139
Provider Business Practice Location Address Fax Number:
732-499-6122
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENISCH
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-499-6139

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  MA28211 , 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: 6846807 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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