MEDICARE: COUNTY OF ATLANTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2073137	OTHER	NJ	AETNA

General Provider Information

NPI Number	:	1366471278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF ATLANTIC

Provider Business Mailing Address
First Line	:	201 S. SHORE ROAD
Second Line	:	COMMUNITY HEALTH
City	:	NORTHFIELD
State	:	NJ
Zip	:	08225
Country	:	US
Telephone Number	:	609-645-5933
Fax Number	:	609-272-8490

Provider Business Practice Location Address
First Line	:	201 SHORE RD
Second Line	:	COMMUNITY HEALTH
City	:	NORTHFIELD
State	:	NJ
Zip	:	08225-2319
Country	:	US
Telephone Number	:	609-645-5933
Fax Number	:	609-272-8490

Authorized Official
Title or Position	:	HEALTH OFFICER
Name	:	PATRICIA DIAMOND
Credential	:
Telephone Number	:	609-645-5935

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	10/21/2008

Similar Medicare Providers

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Practice Location Address:

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1962909663 — ELIZABETH FLORES LCSW
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1538164009 — DR. SCOTT A HERNBERG D.O.
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Directions to “COUNTY OF ATLANTIC ” Practice Location

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