Healthcare Provider Details

I. General information

NPI: 1386652808
Provider Name (Legal Business Name): ONSITE NEONATAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HADDONFIELD BERLIN RD SUITE 210
VOORHEES NJ
08043-3520
US

IV. Provider business mailing address

1000 HADDONFIELD BERLIN RD SUITE 210
VOORHEES NJ
08043-3520
US

V. Phone/Fax

Practice location:
  • Phone: 856-782-2212
  • Fax: 856-782-2213
Mailing address:
  • Phone: 856-782-2212
  • Fax: 856-782-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: MRS. KELLY JACK
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 856-782-2212