Individual
DR. ERIC W. BANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
103 OLD MARLTON PIKE STE 211, MEDFORD, NJ 08055-8772
(609) 953-7500
(609) 953-9085
Mailing address
103 OLD MARLTON PIKE STE 211, MEDFORD, NJ 08055-8772
(609) 953-7500
(609) 953-9085
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
MA48238
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010003124010
—
NJ
01
—
0350808000
AMERIHEALTH HMO PROVIDER
NJ
01
—
0811426
CIGNA PROVIDER #
NJ
01
—
147995
KEYSTONE INSURANCE ID
NJ
01
—
3373326
AETNA PROVIDER ID
NJ
05
—
5312302
—
NJ
01
—
60012703
HORIZON-MERCY
NJ
01
—
721570737
TAX ID#
NJ
05
—
83386
—
NJ
01
—
J017341
TRICARE PRIME PROVIDER ID
NJ
01
—
P381888
OXFORD PROVIDER ID
NJ
Enumeration date
01/23/2007
Last updated
07/05/2012
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