Provider Demographics
NPI:1376782060
Name:MIDATLANTIC NEONATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MIDATLANTIC NEONATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:973-605-8055
Mailing Address - Street 1:140 E HANOVER AVE
Mailing Address - Street 2:BRINJ BLDG
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-2011
Mailing Address - Country:US
Mailing Address - Phone:973-605-8055
Mailing Address - Fax:
Practice Address - Street 1:140 E HANOVER AVE
Practice Address - Street 2:BRINJ BLDG
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2011
Practice Address - Country:US
Practice Address - Phone:973-605-8055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6435505Medicaid