1699784660 NPI number — ONSITE NEONATAL PC

Table of content: (NPI 1699784660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699784660 NPI number — ONSITE NEONATAL PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONSITE NEONATAL PC
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:
1699784660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 HADDONFIELD BERLIN RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-3520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-782-2212
Provider Business Mailing Address Fax Number:
856-782-2213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 HADDONFIELD BERLIN RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-782-2212
Provider Business Practice Location Address Fax Number:
856-782-2213
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HRIC
Authorized Official First Name:
JEROME
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-782-2212

Provider Taxonomy Codes

  • Taxonomy code: 2080N0001X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1011364450001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100788300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com