Provider Demographics
NPI:1710956370
Name:CUMBERLAND NEPHROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:CUMBERLAND NEPHROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-205-9900
Mailing Address - Street 1:1318 S MAIN RD
Mailing Address - Street 2:BUILDING #3
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6516
Mailing Address - Country:US
Mailing Address - Phone:856-205-9900
Mailing Address - Fax:856-205-0041
Practice Address - Street 1:1318 S MAIN RD
Practice Address - Street 2:BUILDING #3
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6516
Practice Address - Country:US
Practice Address - Phone:856-205-9900
Practice Address - Fax:856-205-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:2017-10-24
Deactivation Code:
Reactivation Date:2018-02-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110035388OtherAARP
360907OtherKEYSTONE
1012159OtherAETNA HMO
5414616OtherAETNA PPO
360907OtherAMERIHEALTH PPO
NJ7583702Medicaid
0685688000OtherAMERIHEALTH HMO