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General NPI Number Information
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NPI Number | 1174187728
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Entity Type | Organization
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Legal Business Name | SIGNIFY HEALTH MEDICAL ASSOCIATES OF NEW JERSEY, LLC
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 116 VILLAGE BLVD STE 200
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City | PRINCETON
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State | NJ
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Zip | 08540-5700
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Country | US
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Telephone | 877-868-5351
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Fax |
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Provider Business Mailing Address
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Address Line | 4055 VALLEY VIEW LN STE 400
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City | DALLAS
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State | TX
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Zip | 75244-5071
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Country | US
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Telephone | 972-715-3800
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Fax |
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Authorized Official
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Title or Position | MANAGER, PROVIDER ENROLLMENT
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Name | ROBERT SHAWN BRONKE
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Credential |
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Telephone | 694-909-6446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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