Provider Demographics
NPI:1629034459
Name:BURLINGTON COUNTY
Entity type:Organization
Organization Name:BURLINGTON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PENZINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-702-7550
Mailing Address - Street 1:101 BURRS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-5507
Mailing Address - Country:US
Mailing Address - Phone:609-702-7550
Mailing Address - Fax:609-702-1277
Practice Address - Street 1:101 BURRS RD
Practice Address - Street 2:SUITE C
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-5507
Practice Address - Country:US
Practice Address - Phone:609-702-7550
Practice Address - Fax:609-702-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6900801Medicaid
CG2090OtherRAILROAD MEDICARE
0657133000OtherKEYSTONE HEALTHPLAN
2205005OtherAETNA
783036OtherAMERIHEALTH
0657133000OtherAMERIHEALTH ADMINISTRATOR
032062Medicare ID - Type Unspecified