1538376462 NPI number — FALIVENE AND FALIVENE DDS PA

Table of content: (NPI 1538376462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538376462 NPI number — FALIVENE AND FALIVENE DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALIVENE AND FALIVENE DDS PA
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:
6
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:
1538376462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
232 NORWOOD AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST LONG BRANCH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07764-1860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-222-4694
Provider Business Mailing Address Fax Number:
732-222-1097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
232 NORWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST LONG BRANCH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-222-4694
Provider Business Practice Location Address Fax Number:
732-222-1097
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FALIVENE
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-222-4694

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  22DI00633100 , 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: 122920601 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com