Organization
ONSITE NEONATAL ILLINOIS PC
Active
Parent organization
ONSITE NEONATAL PC
Other names
Illinois
Organization subpart
Yes
Provider details
NPI number
Legal business name
ONSITE NEONATAL PC
Authorized official
KELLY JACK (AR TECHNICAL MANAGER)
(856) 782-2212
Entity
Organization
Contact information
Practice address
1000 HADDONFIELD BERLIN RD STE 210, VOORHEES, NJ 08043-3520
(856) 782-2212
(856) 782-2218
Mailing address
1000 HADDONFIELD BERLIN RD STE 210, VOORHEES, NJ 08043-3520
(856) 782-2212
(856) 782-2218
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
IL
Enumeration date
09/27/2018
Last updated
09/27/2018
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