Provider Demographics
NPI:1629036306
Name:PHILLIPS, HADLEY H (DO)
Entity Type:Individual
Prefix:DR
First Name:HADLEY
Middle Name:H
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1317
Mailing Address - Country:US
Mailing Address - Phone:201-796-2020
Mailing Address - Fax:201-796-4833
Practice Address - Street 1:619 RIVER DR
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1317
Practice Address - Country:US
Practice Address - Phone:201-796-2020
Practice Address - Fax:201-796-4833
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04177700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1042831OtherHORIZON NJ HEALTH PIN
NJ14D63OtherEMPIRE BCBS
NJ16228OtherUNIVERSITY HEALTH PLAN
NJ180001612OtherRAILROAD MEDICARE PIN
NJBS807OtherOXFORD LIBERTY PIN
NJ0073085OtherGHI HMO PIN
NJ0091878OtherAETNA PIN
NJ01000189401OtherAMERICHOICE MEDICAID PIN
NJ16183OtherAMERIGROUP PIN
NJ10D631OtherWELLCHOICE
NJOK7453OtherHEALTHNET PIN
NJ176769OtherUNITED HEALTHCARE PIN
NJ0804391006OtherCIGNA PIN
NJ3163202Medicaid
NJAMERIHEALTHOther00102907000
NJ01682888OtherMEDICAID NY
NJ0804391006OtherCIGNA PIN
NJ176769OtherUNITED HEALTHCARE PIN