Provider Demographics
NPI:1972932747
Name:UNITY PLACE OF ATLANTIC COUNTY, LLC
Entity type:Organization
Organization Name:UNITY PLACE OF ATLANTIC COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TISCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-242-6502
Mailing Address - Street 1:121 S WHITE HORSE PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1871
Mailing Address - Country:US
Mailing Address - Phone:609-704-1313
Mailing Address - Fax:609-704-1208
Practice Address - Street 1:121 S WHITE HORSE PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1871
Practice Address - Country:US
Practice Address - Phone:609-704-1313
Practice Address - Fax:609-704-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ200040810302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization