Provider Demographics
NPI:1427152578
Name:ABSECON MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:ABSECON MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIRCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MP
Authorized Official - Phone:609-484-7066
Mailing Address - Street 1:408 CHRIS GAUPP DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205
Mailing Address - Country:US
Mailing Address - Phone:609-748-5015
Mailing Address - Fax:609-748-0303
Practice Address - Street 1:408 CHRIS GAUPP DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205
Practice Address - Country:US
Practice Address - Phone:609-748-5015
Practice Address - Fax:609-748-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8597502Medicaid
NJ2081659001OtherAMERI HEALTH GROUP #
NJ053598Medicare ID - Type UnspecifiedGROUP #