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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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