Basic Information
| Provider Information | |||||||||
| NPI: | 1538112537 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAVERFORD ANESTHESIA ASSOCIATES-NJ, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8500-4056 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191784056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027094497 | ||||||||
| FaxNumber: | 3027092405 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | ELMER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566418000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 11/02/2007 | ||||||||
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| AuthorizedOfficialLastName: | GOLDSTEIN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6107898070 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0095575 | 05 | NJ | MEDICAID |