Basic Information
| Provider Information | |||||||||
| NPI: | 1801825443 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HACKETTSTOWN EMERGENCY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3012 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198040012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566168100 | ||||||||
| FaxNumber: | 8566161919 | ||||||||
| Practice Location | |||||||||
| Address1: | 651 WILLOW GROVE STREET | ||||||||
| Address2: | |||||||||
| City: | HACKETTSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566168100 | ||||||||
| FaxNumber: | 8566161919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 11/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | OLIVIERI | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8566168100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3423905 | 05 | NJ | MEDICAID |