Provider Demographics
NPI:1396785812
Name:ASSOCIATED PHYSIATRISTS OF SOUTHERN NEW JERSEY PA
Entity type:Organization
Organization Name:ASSOCIATED PHYSIATRISTS OF SOUTHERN NEW JERSEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-757-3879
Mailing Address - Street 1:PO BOX 8505
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-0505
Mailing Address - Country:US
Mailing Address - Phone:856-755-1616
Mailing Address - Fax:856-755-0098
Practice Address - Street 1:1600 HADDON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3101
Practice Address - Country:US
Practice Address - Phone:856-757-3879
Practice Address - Fax:856-757-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ062887OtherAMERIHEALTH ADMINISTRATOR
NJ90000080900OtherAMERICHOICE
NJ30056OtherAETNA
NJ3122301Medicaid
NJCE2009OtherRAILROAD MEDICARE
NJJ814OtherAMERIGROUP
NJ0075563000OtherAMERIHEALTH / KEYSTONE
NJ1018429OtherHORIZON NJ HEALTH
NJ=========OtherTAX ID
NJ3122301Medicaid