NPIMap

Organization Active NPI

Lourdes Perinatology Services

  • Maternal & Fetal Medicine Physician
  • Vineland, NJ
National Provider Identifier
1124278056
Registry record updated Sep 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X
License
25MB06099100 Issued in NJ
Legal business name
LOURDES PERINATOLOGY SERVICES
Practice address
1505 W Sherman Ave
Vineland, NJ 08360-6912
Phone
(856) 507-8500
NPI assigned
Sep 29, 2008
Organization subpart
Yes
Parent organization
LOURDES PERINATOLOGY SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Peter Konchak, D.O.
Title
Lead Physician
Phone
(856) 757-3993

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Maternal & Fetal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VM0101X 25MB06099100 NJ Primary

Addresses

Primary practice location

1505 W Sherman Ave
Vineland, NJ 08360-6912

Mailing address

500 Grove St
Suite 100
Haddon Heights, NJ 08035-1736
Phone (856) 796-9200

Other identifiers 1

IdentifierTypeStateIssuer
3197603MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Lourdes Perinatology Services4 organizations share this tax ID, including this one
Part of
Lourdes Perinatology Services

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222646400000",
    "number": "1124278056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 GROVE ST",
            "address_2": "SUITE 100",
            "city": "HADDON HEIGHTS",
            "state": "NJ",
            "postal_code": "080351736",
            "telephone_number": "856-796-9200",
            "fax_number": "856-310-5603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W SHERMAN AVE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083606912",
            "telephone_number": "856-507-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOURDES PERINATOLOGY SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOURDES PERINATOLOGY SERVICES",
        "enumeration_date": "2008-09-29",
        "last_updated": "2008-09-29",
        "status": "A",
        "authorized_official_last_name": "KONCHAK",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "LEAD PHYSICIAN",
        "authorized_official_telephone_number": "856-757-3993",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207VM0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "NJ",
            "license": "25MB06099100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3197603",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.