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General NPI Number Information
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NPI Number | 1841613361
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Entity Type | Organization
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Legal Business Name | ATLANTICARE
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Dates
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Enumeration Date | 02/04/2014
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 2500 ENGLISH CREEK AVE
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City | EGG HARBOR TOWNSHIP
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State | NJ
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Zip | 08234-5549
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Country | US
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Telephone | 609-407-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 ENGLISH CREEK AVE
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City | EGG HARBOR TOWNSHIP
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State | NJ
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Zip | 08234-5549
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Country | US
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Telephone | 609-407-2273
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Fax |
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Authorized Official
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Title or Position | STAFF PHYSICIAN
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Name | DR. GERALD CAESAR DETATA
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Credential | M.D.
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Telephone | 609-407-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 25MA0400540
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License Number State | NJ
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