Provider Demographics
NPI:1720048358
Name:CENTER FOR ADULT MEDICINE
Entity Type:Organization
Organization Name:CENTER FOR ADULT MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-205-1770
Mailing Address - Street 1:1051 W SHERMAN AVENUE
Mailing Address - Street 2:BLDG 2 STE A
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361
Mailing Address - Country:US
Mailing Address - Phone:856-205-1770
Mailing Address - Fax:856-691-5984
Practice Address - Street 1:1051 W SHERMAN AVENUE
Practice Address - Street 2:BLDG 2 STE A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361
Practice Address - Country:US
Practice Address - Phone:856-205-1770
Practice Address - Fax:856-691-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075288Medicaid
NJ6513808Medicaid