Provider Demographics
NPI:1295866846
Name:TOWNSHIP OF PENNSAUKEN
Entity Type:Organization
Organization Name:TOWNSHIP OF PENNSAUKEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-665-2323
Mailing Address - Street 1:5605 N CRESCENT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-1834
Mailing Address - Country:US
Mailing Address - Phone:856-665-2323
Mailing Address - Fax:
Practice Address - Street 1:5605 N CRESCENT BLVD
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-1834
Practice Address - Country:US
Practice Address - Phone:856-665-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPENN006523416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ53486OtherAMERIGROUP
NJ0538633OtherAETNA
NJ6700608Medicaid
NJ0841172000OtherAMERIHEALTH
NJ0841172000OtherKEYSTONE
NJ590010122OtherRAILROAD MEDICARE
NJ1023168OtherHORIZON NJ HEALTH
NJ91000025700OtherAMERICHOICE
NJ590010122OtherRAILROAD MEDICARE