| NPI |
1811211964 |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
| Entity Type Code |
2 |
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. |
| Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
| Provider Organization Name Legal Business Name |
ADVANCED ENDOCRINOLOGY,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 |
310 WOODSTOWN RD FL 4 |
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 |
SALEM |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name |
NJ |
The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address Postal Code |
080792064 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The date that a record was last updated or changed. |
| Provider Business Practice Location Address Telephone Number |
8562269050 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Provider Enumeration Date |
3/18/2010 |
The first name of the authorized official. |
| Last Update Date |
3/18/2010 |
The date that a record was last updated or changed. |
| Authorized Official Last Name |
SAIF |
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 |
NOMAN |
The first name of the authorized official. |
| Authorized Official Title or Position |
PRESIDENT |
|
| Authorized Official Telephone Number |
8562269050 |
|
| Healthcare Provider Taxonomy Code 1 |
207RE0101X |
|
| Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
| Healthcare Provider Taxonomy Code 2 |
207R00000X |
|
| Provider License Number 2 |
25MA06485600 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 2 |
NJ |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
| Other Provider Identifier 1 |
0059676 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 1 |
05 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 1 |
NJ |
|
| Is Organization Subpart |
N |
|
| Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|
| Healthcare Provider Taxonomy Group 2 |
193200000X MULTI-SPECIALTY GROUP |
|