Provider Demographics
NPI:1578008652
Name:ATLANTICARE PHYSICIANS GROUP
Entity Type:Organization
Organization Name:ATLANTICARE PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:609-722-2022
Mailing Address - Street 1:443 SHORE RD., 2ND FLOOR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-407-7747
Mailing Address - Fax:
Practice Address - Street 1:443 SHORE RD., 2ND FLOOR
Practice Address - Street 2:SUITE 201
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-407-7747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00692600261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care