Provider Demographics
NPI:1831387463
Name:TOWN OF WESTFIELD
Entity type:Organization
Organization Name:TOWN OF WESTFIELD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACTING HEALTH OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNISH
Authorized Official - Suffix:
Authorized Official - Credentials:HO
Authorized Official - Phone:908-789-4070
Mailing Address - Street 1:425 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2123
Mailing Address - Country:US
Mailing Address - Phone:908-789-4070
Mailing Address - Fax:908-789-4076
Practice Address - Street 1:425 E BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2123
Practice Address - Country:US
Practice Address - Phone:908-789-4070
Practice Address - Fax:908-789-4076
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF WESTFIELD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06451400251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ181101Medicare PIN