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1376089706 NPI number — JRE AVE MARIA LLC

NPI Number: 1376089706
Health Care Provider/Practitioner: JRE AVE MARIA LLC

Information about “1376089706” NPI (JRE AVE MARIA LLC) exists in 1376089706 in HTML format HTML  |  1376089706 in plain Text format TXT  |  1376089706 in PDF (Portable Document Format) PDF  |  1376089706 in an XML format XML  formats.

NPI Number : 1376089706 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376089706",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "JRE AVE MARIA LLC",
    "ParentOrgTIN": null,
    "OrgName": "JRE AVE MARIA LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "124 ROUTE 10",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RANDOLPH",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07869-2415",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "973-442-4020",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "124 ROUTE 10",
    "SecondLinePracticeLocationAddress": "UNIT 4",
    "PracticeLocationAddressCityName": "RANDOLPH",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07869-2415",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "973-442-4020",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/09/2017",
    "LastUpdateDate": "01/24/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GHALY",
    "AuthorizedOfficialFirstName": "JOHN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGING MEMBER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "973-442-4020",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "333600000X",
        "TaxonomyName": "Pharmacy",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "NJ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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