Organization
ONSITE NEONATAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY JACK (BILLING SUPERVISOR)
(856) 782-2212
Entity
Organization
Contact information
Practice address
1000 HADDONFIELD BERLIN RD, SUITE 210, VOORHEES, NJ 08043-3520
(856) 782-2212
(856) 782-2213
Mailing address
1000 HADDONFIELD BERLIN RD, SUITE 210, VOORHEES, NJ 08043-3520
(856) 782-2212
(856) 782-2213
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7009801
—
NJ
Enumeration date
08/03/2006
Last updated
09/11/2013
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