Provider Demographics
NPI:1760578876
Name:ATLANTIC EMERGENCY ASSOCIATES, PA - MAINLAND LOCATION
Entity Type:Organization
Organization Name:ATLANTIC EMERGENCY ASSOCIATES, PA - MAINLAND LOCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-871-6562
Mailing Address - Street 1:6896 W. SNOWVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JIMMIE LEEDS ROAD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240
Practice Address - Country:US
Practice Address - Phone:609-652-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ36829OtherKEYSTONE MERCY
NJ611602901OtherENERGY
NJ0075141Medicaid
NJ60018386OtherHORIZON NJ HEALTH
NJ611602901OtherBLACK LUNG
NJ2639764000OtherAMERIHEALTH
NJ30027297OtherKEYSTONE MERCY
NJ611602901OtherLONGSHORE
NJ91001879601OtherAMERICHOICE
NJ1105322OtherAETNA
NJ=========OtherDEVON
NJ30027297OtherKEYSTONE MERCY
NJ=========OtherJERSEYMED
NJ=========001OtherTRICARE