Basic Information
| Provider Information | |||||||||
| NPI: | 1558866814 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONSITE NEONATAL TEXAS PLLC | ||||||||
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| OtherOrganizationName: | TEXAS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 HADDONFIELD BERLIN RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080433520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567822212 | ||||||||
| FaxNumber: | 8567822218 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 HADDONFIELD BERLIN RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080433520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567822212 | ||||||||
| FaxNumber: | 8567822218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2018 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | JACK | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | AR TECHNICAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8567822212 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ONSITE NEONATAL PA | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.