=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881618494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLANTICARE PHYSICIAN GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 ENGLISH CREEK AVE BUILDING 900 SUITE 905
-----------------------------------------------------
City | EGG HARBOR TOWNSHIP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08234-5549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-407-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 ENGLISH CREEK AVE BLDG 900
-----------------------------------------------------
City | EGG HARBOR TOWNSHIP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08234-5549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-569-7866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROFESSIONAL REVENUE CYCLE BUSINES
-----------------------------------------------------
Name | ROBIN G DESHIELDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-272-6860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------