Organization
ATLANTICARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD CAESAR DETATA M.D. (STAFF PHYSICIAN)
(609) 407-2273
Entity
Organization
Contact information
Practice address
2500 ENGLISH CREEK AVE, EGG HARBOR TOWNSHIP, NJ 08234-5549
(609) 407-2273
Mailing address
2500 ENGLISH CREEK AVE, EGG HARBOR TOWNSHIP, NJ 08234-5549
(609) 407-2273
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
25MA0400540
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22644986B
IMP
NJ
01
—
C55019
UPIN
NJ
Enumeration date
02/04/2014
Last updated
02/04/2014
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