Basic Information
| Provider Information | |||||||||
| NPI: | 1881930113 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTICARE PHYSICIAN GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE STE 211 | ||||||||
| Address2: | |||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096777776 | ||||||||
| FaxNumber: | 6096777509 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE STE 211 | ||||||||
| Address2: | |||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096777776 | ||||||||
| FaxNumber: | 6096777509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2012 | ||||||||
| LastUpdateDate: | 12/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | SCHROEDER | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | APN | ||||||||
| AuthorizedOfficialTelephone: | 6096777776 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CRNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 26NJ000403300 | NJ | Y | Hospitals | General Acute Care Hospital |
No ID Information.