1215965231 NPI number — EMERGENCY PHYSICIAN ASSOCIATES OF SOUTH JERSEY P C

Table of content: (NPI 1215965231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215965231 NPI number — EMERGENCY PHYSICIAN ASSOCIATES OF SOUTH JERSEY P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY PHYSICIAN ASSOCIATES OF SOUTH JERSEY P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VIRTUA HEALTH
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215965231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 S EVERGREEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08096-2739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-686-4316
Provider Business Mailing Address Fax Number:
865-291-3254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CARNIE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-686-4300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ISTVAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-686-4300

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3440508 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3151000 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3384608 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3151107 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3440605 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0090361 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3384705 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3384802 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3431509 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3440800 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016997300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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