Healthcare Provider Details

I. General information

NPI: 1295514669
Provider Name (Legal Business Name): NASPAC 1 PRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GLASGOW AVE
NEWARK DE
19702-4773
US

IV. Provider business mailing address

404 CREEK CROSSING BLVD
HAINESPORT NJ
08036-2768
US

V. Phone/Fax

Practice location:
  • Phone: 302-439-3063
  • Fax: 302-439-3372
Mailing address:
  • Phone: 609-845-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENEE BOGDOL
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 609-845-3988