Provider Demographics
NPI:1770539058
Name:1450 ASSOCIATES, LLC
Entity type:Organization
Organization Name:1450 ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-794-8664
Mailing Address - Street 1:1550 E CHESTNUT AVE
Mailing Address - Street 2:BUILDING 4, SUITE C
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-8485
Mailing Address - Country:US
Mailing Address - Phone:856-794-8664
Mailing Address - Fax:856-794-2671
Practice Address - Street 1:1119 HIGHWAY 77
Practice Address - Street 2:SUITE 2C
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3649
Practice Address - Country:US
Practice Address - Phone:856-453-1555
Practice Address - Fax:856-453-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23367261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2237566000OtherAMERIHEALTH
S992861OtherCIGNA/AIM
16802OtherAMERIGROUP
2K3084OtherHEALTHNET
A2891314OtherOXFORD
NJ8667802Medicaid
01000441402OtherAMERICHOICE
1156711OtherHORIZON NJ HEALTH
NJCJ3996OtherRAILROAD MEDICARE
077OtherHEALTHNET/CARECORE
2K3084OtherHEALTHNET