Provider Demographics
NPI:1124166509
Name:PINNACLE HEALTHCARE LLC
Entity type:Organization
Organization Name:PINNACLE HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAJAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRADIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-993-2221
Mailing Address - Street 1:36 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1367
Mailing Address - Country:US
Mailing Address - Phone:973-412-1000
Mailing Address - Fax:973-412-1983
Practice Address - Street 1:36 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1367
Practice Address - Country:US
Practice Address - Phone:973-412-1000
Practice Address - Fax:973-412-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006451003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3192553OtherNCPDP PROVIDER IDENTIFICATION NUMBER