Healthcare Provider Details

I. General information

NPI: 1538112537
Provider Name (Legal Business Name): HAVERFORD ANESTHESIA ASSOCIATES-NJ, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FRONT ST
ELMER NJ
08318
US

IV. Provider business mailing address

PO BOX 8500-4056
PHILADELPHIA PA
19178-4056
US

V. Phone/Fax

Practice location:
  • Phone: 856-641-8000
  • Fax:
Mailing address:
  • Phone: 302-709-4497
  • Fax: 302-709-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: WILLIAM GOLDSTEIN
Title or Position: PARTNER
Credential: MD
Phone: 610-789-8070