Provider Demographics
NPI:1225016363
Name:ASHONG, EMMANUEL F (M D)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:F
Last Name:ASHONG
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:FREDERICK
Other - Middle Name:
Other - Last Name:ASHONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 GROVE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1761
Mailing Address - Country:US
Mailing Address - Phone:856-796-9200
Mailing Address - Fax:856-796-9397
Practice Address - Street 1:1601 HADDON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3109
Practice Address - Country:US
Practice Address - Phone:856-757-3700
Practice Address - Fax:856-365-7972
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05583000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4523202Medicaid
I44081Medicare UPIN
NJ235956C04Medicare PIN