1245722164 NPI number — JEFFREY ADAM FEHDER APN-CRNA

Table of content: JEFFREY ADAM FEHDER APN-CRNA (NPI 1245722164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245722164 NPI number — JEFFREY ADAM FEHDER APN-CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEHDER
Provider First Name:
JEFFREY
Provider Middle Name:
ADAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN-CRNA
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:
1245722164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HIGHGATE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08003-1811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-912-8345
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CAPITAL HEALTH MEDICAL CENTER - HOPEWELL
Provider Second Line Business Practice Location Address:
1 CAPITAL WAY - SECOND FLOOR, ANESTHESIA OFFICES
Provider Business Practice Location Address City Name:
PENNINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-396-4700
Provider Business Practice Location Address Fax Number:
954-616-3877
Provider Enumeration Date:
06/06/2018

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: 367500000X , with the licence number:  26NJ00825900 , 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)