Provider Demographics
NPI:1548202922
Name:HAMMONTON ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:HAMMONTON ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DECLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-561-6700
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-0558
Mailing Address - Country:US
Mailing Address - Phone:609-561-6700
Mailing Address - Fax:
Practice Address - Street 1:600 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2014
Practice Address - Country:US
Practice Address - Phone:609-561-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0073954Medicaid
NJ093478Medicare ID - Type Unspecified