Facts
- Status
- A
- Credential
- D.O.
- Type
- Individual
- Enumeration date
- 2006-07-19
- Last updated
- 2010-02-08
Licenses
- License NJ
- MB70308
- License NJ
- 25MB07030800
Location
- Practice location
- 11 PARKE PLACE BLVD, SUITE A
- City
- SEWELL NJ
- Postal code
- 080802664
- Phone
- 856-218-4848
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.