Provider Demographics
NPI:1922013366
Name:BOROUGH OF WILDWOOD CREST
Entity Type:Organization
Organization Name:BOROUGH OF WILDWOOD CREST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOROUGH CLERK
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YECCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-522-5176
Mailing Address - Street 1:6101 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD CREST
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-4113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6101 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD CREST
Practice Address - State:NJ
Practice Address - Zip Code:08260-4113
Practice Address - Country:US
Practice Address - Phone:609-522-5176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3416L0300X3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
91000989200OtherAMERICHOICE OF NJ
30020586OtherKEYSTONE MERCY HEALTH PLA
3181877OtherAETNA HMO
NJ9110909Medicaid
2159308000OtherAMERIHEALTH HMO NJ DE
P00007707OtherRAILROAD MEDICARE
1172598OtherHORIZON NJ HEALTH
A28787660OtherOXFORD HEALTH PLANS
P00007707OtherRAILROAD MEDICARE
A28787660OtherOXFORD HEALTH PLANS
2159308000OtherAMERIHEALTH HMO NJ DE
=========OtherHORIZON BC/BS OF NJ
=========OtherTRICARE (CHAMPUS)
=========OtherAETNA (NON HMO)
NJ9110909Medicaid