NPI |
1053832758 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
MMS HEALTHCARE MANAGEMENT LLC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
241 MAIN ST FL 4 |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Business Practice Location Address City Name |
HACKENSACK |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
NJ |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
076015715 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
2019969035 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
7/3/2017 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
7/21/2017 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
MOLINA |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
CARLOS |
The first name of the authorized official. |
Authorized Official Title or Position |
BUSINESS MANAGER |
The title or position of the authorized official. |
Authorized Official Telephone Number |
2019969035 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
208D00000X |
The 10-position telephone number of the authorized official. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MR. |
|
Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|