Provider Demographics
NPI:1558866814
Name:ONSITE NEONATAL TEXAS PLLC
Entity Type:Organization
Organization Name:ONSITE NEONATAL TEXAS PLLC
Other - Org Name:TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AR TECHNICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-782-2212
Mailing Address - Street 1:1000 HADDONFIELD BERLIN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3520
Mailing Address - Country:US
Mailing Address - Phone:856-782-2212
Mailing Address - Fax:856-782-2218
Practice Address - Street 1:1000 HADDONFIELD BERLIN RD STE 210
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3520
Practice Address - Country:US
Practice Address - Phone:856-782-2212
Practice Address - Fax:856-782-2218
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONSITE NEONATAL PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty