Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | MA48238 | NJ |
NPI | 1124172598 |
---|---|
Provider Name | Dr. Eric W. Bantz |
First Address | Medford, NJ 08055-8772 |
Second Address | Medford, NJ 08055-8772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 05/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010003124010 | (05) | NJ |
0350808000 | AMERIHEALTH HMO PROVIDER (01) | NJ |
0811426 | CIGNA PROVIDER # (01) | NJ |
147995 | KEYSTONE INSURANCE ID (01) | NJ |
3373326 | AETNA PROVIDER ID (01) | NJ |
5312302 | (05) | NJ |
60012703 | HORIZON-MERCY (01) | NJ |
721570737 | TAX ID# (01) | NJ |
83386 | (05) | NJ |
F44045 | (02) | NJ |
J017341 | TRICARE PRIME PROVIDER ID (01) | NJ |
P381888 | OXFORD PROVIDER ID (01) | NJ |