Basic Information
Provider Information | |||||||||
NPI: | 1558665786 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HSWL FO CAPE MAY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2 W DELAWARE PKWY | ||||||||
Address2: |   | ||||||||
City: | VILLAS | ||||||||
State: | NJ | ||||||||
PostalCode: | 08251 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6097707641 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1 MUNRO AVE | ||||||||
Address2: |   | ||||||||
City: | CAPE MAY | ||||||||
State: | NJ | ||||||||
PostalCode: | 082045000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6098986964 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/03/2011 | ||||||||
LastUpdateDate: | 01/03/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BIANES | ||||||||
AuthorizedOfficialFirstName: | JOCELYN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | REGISTERED NURSE | ||||||||
AuthorizedOfficialTelephone: | 6098986964 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 26NR14790000 | NJ | N |   | Hospitals | General Acute Care Hospital |   | 2865M2000X | 0001218487 | VA | Y |   | Hospitals | Military Hospital | Military General Acute Care Hospital |
No ID Information.