Healthcare Provider Details

I. General information

NPI: 1023235942
Provider Name (Legal Business Name): ATLANTICARE REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ATLANTIC AVE STE 1000
ATLANTIC CITY NJ
08401-7022
US

IV. Provider business mailing address

1401 ATLANTIC AVE STE 1000
ATLANTIC CITY NJ
08401-7022
US

V. Phone/Fax

Practice location:
  • Phone: 609-441-7088
  • Fax: 609-441-7089
Mailing address:
  • Phone: 609-441-7088
  • Fax: 609-441-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number28RS00672400
License Number StateNJ

VIII. Authorized Official

Name: STEVEN MOSCOLA
Title or Position: PHARMACY DIRECTOR
Credential: B.S.
Phone: 732-598-1944