Provider Demographics
NPI:1275563595
Name:HADDON RENAL MEDICAL SPECIALISTS, PA
Entity Type:Organization
Organization Name:HADDON RENAL MEDICAL SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-428-8992
Mailing Address - Street 1:401 KINGS HWY S
Mailing Address - Street 2:BUILDING 5
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2500
Mailing Address - Country:US
Mailing Address - Phone:856-428-8992
Mailing Address - Fax:856-428-9614
Practice Address - Street 1:401 KINGS HWY S
Practice Address - Street 2:BUILDING 5
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2500
Practice Address - Country:US
Practice Address - Phone:856-428-8992
Practice Address - Fax:856-428-9614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2651700Medicaid
NJ015758AB5Medicare PIN