Basic Information
| Provider Information | |||||||||
| NPI: | 1619062015 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | US COAST GUARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MUNRO AVE | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082045000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098986610 | ||||||||
| FaxNumber: | 6098986962 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MUNRO AVE | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082045000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098986610 | ||||||||
| FaxNumber: | 6098986962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | HERSHBERG | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
| AuthorizedOfficialMiddleName: | ANDREW | ||||||||
| AuthorizedOfficialTitleorPosition: | HS2 | ||||||||
| AuthorizedOfficialTelephone: | 6098986291 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | HEALTH SERVICES TECH | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | 24720000X | DC | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.