Healthcare Provider Details

I. General information

NPI: 1003820622
Provider Name (Legal Business Name): ATLANTICARE PHYSICIAN GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E JIMMIE LEEDS RD
GALLOWAY NJ
08205-9479
US

IV. Provider business mailing address

2500 ENGLISH CREEK AVE BLDG 900
EGG HARBOR TOWNSHIP NJ
08234-5549
US

V. Phone/Fax

Practice location:
  • Phone: 609-748-2100
  • Fax: 609-748-2101
Mailing address:
  • Phone: 609-407-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBIN DESHIELDS
Title or Position: PROFESSIONAL REV CYCLE BUS PARTNER
Credential:
Phone: 609-272-6860