Healthcare Provider Details

I. General information

NPI: 1700018272
Provider Name (Legal Business Name): ANNA M. GODYN,MD. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CROSSWICKS RD SUITE 2
BORDENTOWN NJ
08505-2602
US

IV. Provider business mailing address

231 CROSSWICKS RD SUITE 2
BORDENTOWN NJ
08505-2602
US

V. Phone/Fax

Practice location:
  • Phone: 609-298-7204
  • Fax: 609-298-0491
Mailing address:
  • Phone: 609-298-7204
  • Fax: 609-298-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMA046193
License Number StateNJ

VIII. Authorized Official

Name: MRS. DAWN M BERGER
Title or Position: OFFICE MANAGER
Credential:
Phone: 609-298-7204