Provider Demographics
NPI:1710013198
Name:ATLANTIC CITY GYNECOLOGY GROUP
Entity Type:Organization
Organization Name:ATLANTIC CITY GYNECOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:6093-444-5554
Mailing Address - Street 1:1616 PACIFIC AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6939
Mailing Address - Country:US
Mailing Address - Phone:609-344-4554
Mailing Address - Fax:609-348-2565
Practice Address - Street 1:1616 PACIFIC AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6939
Practice Address - Country:US
Practice Address - Phone:609-344-4554
Practice Address - Fax:609-348-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10161 A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5363403Medicaid