NPI |
1598120180 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
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 |
BACK TO LIFE HEALTH AND WELLNESS |
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 |
1806 HIGHWAY 35 STE 108 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
OAKHURST |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Provider Business Practice Location Address State Name |
NJ |
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). |
Provider Business Practice Location Address Postal Code |
077552766 |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The first name of the provider, if the provider
is an individual. |
Provider Business Practice Location Address Telephone Number |
7325089808 |
The middle name of the provider, if the provider
is an individual. |
Provider Enumeration Date |
12/23/2015 |
Other last name by which the provider being identified is or has been known. |
Last Update Date |
12/23/2015 |
Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only. |
Authorized Official Last Name |
CARUSO |
Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider middle name’’ if the provider
is or has been known by a different last name only. |
Authorized Official First Name |
GIULIO |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Authorized Official Title or Position |
PRESIDENT |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Authorized Official Telephone Number |
7325089808 |
The city name in the location address of the provider being identified. |
Healthcare Provider Taxonomy Code 1 |
111N00000X |
The State code in the location of the provider
being identified. |
Provider License Number 1 |
38MC00459700 |
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 License Number State Code 1 |
NJ |
The country code in the location address of the provider being identified. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The telephone number associated with the location address of the provider being identified. |
Is Organization Subpart |
N |
The date the provider was assigned a unique identifier (assigned an NPI). |
Authorized Official Name Prefix Text |
DR. |
The date that a record was last updated or changed. |
Authorized Official Credential Text |
D.C. |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |