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Organization
MAINBRIDGE MEDICAL
Active
Organization
MAINBRIDGE MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONARD S KATZ D.O. (OWNER)
(609) 877-0644
Entity
Organization
Contact information
Practice address
1 MAINBRIDGE LN, WILLINGBORO, NJ 08046-2103
(609) 877-0646
(609) 877-0370
Mailing address
PO BOX 8627, CHERRY HILL, NJ 08002-0627
(856) 755-1616
(856) 755-0098
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019423
AMERIHEALTH ADMINISTRATOR
NJ
01
—
0471676001
AMERIHEALTH HMO/PPO
NJ
01
—
10169
AETNA HMO
—
01
—
5868520
AETNA PPO
—
05
—
8159009
—
NJ
Enumeration date
05/11/2006
Last updated
08/22/2020
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