Basic Information
Provider Information | |||||||||
NPI: | 1306872296 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | WILLIAM B. KESSLER MEMORIAL HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | KESSLER MEMORIAL HOSPITAL | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 600 S WHITE HORSE PIKE | ||||||||
Address2: |   | ||||||||
City: | HAMMONTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 080372099 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6095616700 | ||||||||
FaxNumber: | 6097041269 | ||||||||
Practice Location | |||||||||
Address1: | 600 S WHITE HORSE PIKE | ||||||||
Address2: |   | ||||||||
City: | HAMMONTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 080372099 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6095616700 | ||||||||
FaxNumber: | 6097041269 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/23/2006 | ||||||||
LastUpdateDate: | 11/07/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ROSSI | ||||||||
AuthorizedOfficialFirstName: | JAMES | ||||||||
AuthorizedOfficialMiddleName: | M. | ||||||||
AuthorizedOfficialTitleorPosition: | INTERIM CEO | ||||||||
AuthorizedOfficialTelephone: | 6095616700 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 10104 | NJ | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 0001227000 | 01 | NJ | AMERIHEALTH/KEYSTONE BC | OTHER | 00434244 | 05 | NY |   | MEDICAID | 0478212 | 01 | NJ | CIGNA | OTHER | 35891 | 01 | NJ | UNITED HEALTHCARE | OTHER | J004637 | 01 | NJ | CHAMPUS - TRICARE | OTHER | 300003269A | 05 | GA |   | MEDICAID | 3676404 | 05 | NJ |   | MEDICAID | 50301 | 01 | NJ | AMERIGROUP | OTHER | IL5511 | 01 | NJ | ACS/HEALTHNET | OTHER | 13063 | 01 | NJ | AETNA US HEALTHCARE | OTHER | 01000419500 | 01 | NJ | AMERICHOICE | OTHER | 23418 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER | 5361303 | 05 | NJ |   | MEDICAID | 912671600 | 05 | FL |   | MEDICAID | 45564 | 01 | NJ | HORIZON NJ | OTHER | HO5100 | 01 | NJ | OXFORD | OTHER |