1811219447 NPI number — ALLERGY AND ASTHMA CENTER OF NORTHERN NEW JERSEY LLC

Table of content: MS. BARBARA JANE NISTOR CRNP (NPI 1588249957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811219447 NPI number — ALLERGY AND ASTHMA CENTER OF NORTHERN NEW JERSEY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY AND ASTHMA CENTER OF NORTHERN NEW JERSEY LLC
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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811219447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 PIERMONT RD STE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOSTER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07624-2846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-564-7777
Provider Business Mailing Address Fax Number:
201-564-7776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 PIERMONT RD STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOSTER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07624-2846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-564-7777
Provider Business Practice Location Address Fax Number:
201-564-7776
Provider Enumeration Date:
02/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MINIKES
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-564-7777

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA42598 , 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)





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