Provider Demographics
NPI:1053365973
Name:ON-SITE SPECIALTY CARE, LLC
Entity type:Organization
Organization Name:ON-SITE SPECIALTY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:610-613-9614
Mailing Address - Street 1:15 EAST NEW CASTLE ROAD
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-4725
Mailing Address - Country:US
Mailing Address - Phone:609-602-2908
Mailing Address - Fax:856-231-9699
Practice Address - Street 1:3001 E EVESHAM RD
Practice Address - Street 2:ON-SITE SPECIALTY CARE-CRNP
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9547
Practice Address - Country:US
Practice Address - Phone:610-613-9614
Practice Address - Fax:253-663-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018016410002Medicaid
NJ8186308Medicaid
NJ8186308Medicaid
PA037087Medicare PIN