Basic Information
| Provider Information | |||||||||
| NPI: | 1548202922 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAMMONTON ANESTHESIA ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 558 | ||||||||
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| City: | HAMMONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080370558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095616700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 S WHITE HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | HAMMONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080372014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095616700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DECLEMENT | ||||||||
| AuthorizedOfficialFirstName: | FREDERICK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6095616700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0073954 | 05 | NJ | MEDICAID |