Provider Demographics
NPI:1164604518
Name:PEQUANNOCK TOWNSHIP
Entity Type:Organization
Organization Name:PEQUANNOCK TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:CORREALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-835-5700
Mailing Address - Street 1:530 NEWARK POMPTON TPKE
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1744
Mailing Address - Country:US
Mailing Address - Phone:973-835-5700
Mailing Address - Fax:973-835-4328
Practice Address - Street 1:530 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1744
Practice Address - Country:US
Practice Address - Phone:973-835-5700
Practice Address - Fax:973-835-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ172606Medicare PIN