1619008265 NPI number — GLOUCESTER TOWNSHIP EMS ALLIANCE INC

Table of content: (NPI 1619008265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619008265 NPI number — GLOUCESTER TOWNSHIP EMS ALLIANCE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLOUCESTER TOWNSHIP EMS ALLIANCE INC
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:
Provider Other Organization Name Type Code:
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:
1619008265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1016
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-7016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-784-3715
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 N BLACK HORSE PIKE
Provider Second Line Business Practice Location Address:
SUITE 5D
Provider Business Practice Location Address City Name:
BLACKWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08012-3098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-481-8429
Provider Business Practice Location Address Fax Number:
856-481-4930
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CURREY
Authorized Official First Name:
RAY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-481-4829

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  GEB0032 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 590014943 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1144886 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2007030000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2007030000 . This is a "KEYSTONE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: J19901 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2530700 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8807604 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91000249300 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 34319 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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