Basic Information
Provider Information | |||||||||
NPI: | 1639267339 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AMENDOLIA | ||||||||
FirstName: | BARBARA | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN, NNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 FEDERAL ST STE SW200 | ||||||||
Address2: |   | ||||||||
City: | CAMDEN | ||||||||
State: | NJ | ||||||||
PostalCode: | 081031155 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8563564924 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1 COOPER PLZ | ||||||||
Address2: | DORRANCE 7TH FLOOR | ||||||||
City: | CAMDEN | ||||||||
State: | NJ | ||||||||
PostalCode: | 081031461 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8563422265 | ||||||||
FaxNumber: | 8563428007 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/10/2006 | ||||||||
LastUpdateDate: | 06/20/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0000X | NJ00065800 | NJ | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal | 363LN0000X | NO08741800 | NJ | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
ID Information
ID | Type | State | Issuer | Description | 2549177 | 01 | NJ | UNITED HEALTHCARE | OTHER | 010007350 | 01 | NJ | AMERICHOICE | OTHER | 3K6804 | 01 | NJ | HEALTHNET | OTHER | P3600832 | 01 | NJ | OXFORD | OTHER | 42282 | 01 | NJ | UNIVERSITY HEALTHPLAN | OTHER |