Basic Information
Provider Information | |||||||||
NPI: | 1376637124 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOUSTON | ||||||||
FirstName: | PATRICK | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 FEDERAL ST # 200 | ||||||||
Address2: |   | ||||||||
City: | CAMDEN | ||||||||
State: | NJ | ||||||||
PostalCode: | 081031088 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8563564924 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3 COOPER PLZ | ||||||||
Address2: | SUITE 411 | ||||||||
City: | CAMDEN | ||||||||
State: | NJ | ||||||||
PostalCode: | 081031438 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8563423275 | ||||||||
FaxNumber: | 8569688468 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/03/2006 | ||||||||
LastUpdateDate: | 10/05/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/05/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | MA27374 | NJ | Y |   | Allopathic & Osteopathic Physicians | Otolaryngology |   |
ID Information
ID | Type | State | Issuer | Description | 010004041 | 01 | NJ | AMERICHOICE | OTHER | 0391363006 | 01 | NJ | CIGNA | OTHER | 0081427000 | 01 | NJ | AMERIHEALTH/KEYSTONE/IBC | OTHER | 60018006 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 390689 | 01 | NJ | UNITED HEALTHCARE | OTHER | 2905108 | 05 | NJ |   | MEDICAID | 29335 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER | 3K6086 | 01 | NJ | HEALTHNET | OTHER | P408277 | 01 | NJ | OXFORD | OTHER | 122670 | 01 | NJ | AMERIHEALTH PPO/PABS | OTHER | 1071240 | 01 | NJ | AETNA | OTHER |