1437259124 NPI number — KATHLEEN M HEINTZ DO

Table of content: KATHLEEN M HEINTZ DO (NPI 1437259124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437259124 NPI number — KATHLEEN M HEINTZ DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEINTZ
Provider First Name:
KATHLEEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

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:
1437259124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 COOPER PLZ
Provider Second Line Business Mailing Address:
KELEMAN 404
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08103-1461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-342-2034
Provider Business Mailing Address Fax Number:
856-342-6608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 COOPER PLZ
Provider Second Line Business Practice Location Address:
SUITE 311
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08103-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-342-2034
Provider Business Practice Location Address Fax Number:
856-342-6608
Provider Enumeration Date:
09/23/2006

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: 207RC0000X , with the licence number:  MB61322 , 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: 010003878 00 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060060586 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10658339 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3K5960 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: PI863791 . This is a "OXFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2230568 . This is a "AETNA US-HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7965109 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0347034000 . This is a "AMERIHEALTH, HMO, KEYSTONE, IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1953539 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 572159 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8352825 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 24646 . This is a "UNIVERSITY HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1103307 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".




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