Healthcare Provider Details

I. General information

NPI: 1922013366
Provider Name (Legal Business Name): BOROUGH OF WILDWOOD CREST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PACIFIC AVE
WILDWOOD CREST NJ
08260-4113
US

IV. Provider business mailing address

6101 PACIFIC AVE
WILDWOOD CREST NJ
08260-4113
US

V. Phone/Fax

Practice location:
  • Phone: 609-522-5176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3416L0300X
License Number StateNJ

VIII. Authorized Official

Name: KEVIN YECCO
Title or Position: BOROUGH CLERK
Credential:
Phone: 609-522-5176