Healthcare Provider Details

I. General information

NPI: 1457627986
Provider Name (Legal Business Name): SIX FLAGS GREAT ADVENTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SIX FLAGS BLVD
JACKSON NJ
08527-5369
US

IV. Provider business mailing address

1 SIX FLAGS BLVD
JACKSON NJ
08527-5369
US

V. Phone/Fax

Practice location:
  • Phone: 732-928-2000
  • Fax: 732-928-4083
Mailing address:
  • Phone: 732-928-2000
  • Fax: 732-928-4083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberSIXF00530
License Number StateNJ

VIII. Authorized Official

Name: CHUCK MCSWEENEY
Title or Position: CONSULTANT
Credential:
Phone: 856-784-3715