1679588222 NPI number — MOBILE ANESTHESIA CARE

Table of content: (NPI 1679588222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679588222 NPI number — MOBILE ANESTHESIA CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE ANESTHESIA CARE
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:
1679588222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 318
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:
08043-0318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-587-7775
Provider Business Mailing Address Fax Number:
609-587-7955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2271 HIGHWAY 33
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08690-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-890-4080
Provider Business Practice Location Address Fax Number:
609-890-4090
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SACKSTEIN
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
609-890-4080

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  MA060803 , 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)





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