Provider Demographics
NPI:1124112768
Name:ATLANTIC EMERGENCY ASSOCIATES, PA
Entity type:Organization
Organization Name:ATLANTIC EMERGENCY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-639-2747
Mailing Address - Street 1:PO BOX 411020
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-1020
Mailing Address - Country:US
Mailing Address - Phone:610-639-2747
Mailing Address - Fax:
Practice Address - Street 1:1925 PACIFIC AVENUE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401
Practice Address - Country:US
Practice Address - Phone:609-345-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ611602900OtherFECA
NJ611602900OtherENERGY
NJ30027297OtherKEYSTONE MERCY
NJ36829OtherHEALTH PARTNERS
NJ91001879600OtherAMERICHOICE
NJ0075141Medicaid
NJ2639764000OtherAMERIHEALTH
NJ60018386OtherHORIZON NJ HEALTH
NJ611602900OtherBLACK LUNG
NJ1105322OtherAETNA
NJ=========001OtherTRICARE
NJ611602900OtherFECA
NJ611602900OtherBLACK LUNG
NJ=========OtherJERSEYMED
NJ0075141Medicaid