1760578876 NPI number — ATLANTIC EMERGENCY ASSOCIATES, PA - MAINLAND LOCATION

Table of content: (NPI 1760578876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760578876 NPI number — ATLANTIC EMERGENCY ASSOCIATES, PA - MAINLAND LOCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC EMERGENCY ASSOCIATES, PA - MAINLAND LOCATION
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:
1760578876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6896 W. SNOWVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRECKSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JIMMIE LEEDS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-652-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALSH
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANGER
Authorized Official Telephone Number:
215-871-6562

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36829 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 611602901 . This is a "ENERGY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0075141 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60018386 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 611602901 . This is a "BLACK LUNG" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2639764000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 30027297 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 611602901 . This is a "LONGSHORE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 91001879601 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1105322 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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