Provider Demographics
NPI:1205912391
Name:JADICK, ANTHONY MARTIN (CRNA)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MARTIN
Last Name:JADICK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 JESSE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELMER
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-4562
Mailing Address - Country:US
Mailing Address - Phone:856-692-2609
Mailing Address - Fax:
Practice Address - Street 1:1051 W SHERMAN AVE
Practice Address - Street 2:BLDG.2 SUITE A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6931
Practice Address - Country:US
Practice Address - Phone:856-691-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR05322900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse