Provider Demographics
NPI:1194764324
Name:OWENS, JOHN S (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:OWENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W RED BANK AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1630
Mailing Address - Country:US
Mailing Address - Phone:856-845-6807
Mailing Address - Fax:856-845-3760
Practice Address - Street 1:17 W RED BANK AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-845-6807
Practice Address - Fax:856-845-3760
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA28117207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP499317OtherOXFORD
NJ1684507Medicaid
NJ33422OtherAETNA HMO
NJ0080962000OtherAMERIHEALTH
NJ118024OtherAMERIHEALTH ADMINISTRATOR
PA0080962000OtherPENNSYLVANIA BLUE SHIELD
PA649608POCMedicare ID - Type UnspecifiedPENNSYLVANIA MEDICARE
NJ118024OtherAMERIHEALTH ADMINISTRATOR
NJ118024BAGMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER