1912991142 NPI number — DR. BARRY SHURMAN MD

Table of content: DR. BARRY SHURMAN MD (NPI 1912991142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912991142 NPI number — DR. BARRY SHURMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHURMAN
Provider First Name:
BARRY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1912991142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1710
Provider Second Line Business Mailing Address:
SOUTH JERSEY RADIOLOGY ASSOC, PA
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-7710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-770-0504
Provider Business Mailing Address Fax Number:
856-770-0395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CARNIE BLVD
Provider Second Line Business Practice Location Address:
SUITE B-5
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-4512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-751-0123
Provider Business Practice Location Address Fax Number:
856-751-0535
Provider Enumeration Date:
09/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  25MA03253300 , 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: 1088649 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 597510 . This is a "HIGHMARK PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: A3738029 . This is a "OXFORD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1241874 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2400308 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0419907000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300047131 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0732416 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 597510 . This is a "PREMIER BLUE" identifier . This identifiers is of the category "OTHER".




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