1023047180 NPI number — RANCOCAS OBSTETRICS AND GYNECOLOGY ASSOCIATES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023047180 NPI number — RANCOCAS OBSTETRICS AND GYNECOLOGY ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANCOCAS OBSTETRICS AND GYNECOLOGY ASSOCIATES, LLC
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:
1023047180
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:
220 SUNSET RD
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
WILLINGBORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08046-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-877-8777
Provider Business Mailing Address Fax Number:
609-877-2497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 SUNSET RD
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
WILLINGBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08046-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-877-8777
Provider Business Practice Location Address Fax Number:
609-877-2497
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
609-877-8777

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , 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: 1K7588 . This is a "HEALTHNET PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2039932 . This is a "OXFORD PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0060481000 . This is a "AMERIHEALTH PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0877648000 . This is a "KEYSTONE PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7903600 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2456024 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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