Provider Demographics
NPI:1992978621
Name:ATLANTICARE REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:ATLANTICARE REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT MATERIALS MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MALVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-383-2110
Mailing Address - Street 1:6685 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-1827
Mailing Address - Country:US
Mailing Address - Phone:609-407-6360
Mailing Address - Fax:609-407-6361
Practice Address - Street 1:6685 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-1827
Practice Address - Country:US
Practice Address - Phone:609-407-6360
Practice Address - Fax:609-407-6361
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTICARE REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10102341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0135895Medicaid
NJ310064Medicare UPIN