Provider Demographics
NPI:1023235942
Name:ATLANTICARE REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:ATLANTICARE REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:732-598-1944
Mailing Address - Street 1:1401 ATLANTIC AVE
Mailing Address - Street 2:STE 1000
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-7022
Mailing Address - Country:US
Mailing Address - Phone:609-441-7088
Mailing Address - Fax:609-441-7089
Practice Address - Street 1:1401 ATLANTIC AVE
Practice Address - Street 2:STE 1000
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7022
Practice Address - Country:US
Practice Address - Phone:609-441-7088
Practice Address - Fax:609-441-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006724003336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2056132OtherPK