Healthcare Provider Details

I. General information

NPI: 1356983860
Provider Name (Legal Business Name): SVETLANA BABENKO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LAUREL HEIGHTS DR
BRIDGETON NJ
08302-3635
US

IV. Provider business mailing address

402 LIPPINCOTT DR
MARLTON NJ
08053-4112
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-4800
  • Fax:
Mailing address:
  • Phone: 856-782-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00954800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: