Healthcare Provider Details

I. General information

NPI: 1417064973
Provider Name (Legal Business Name): NEIL D BLUEBOND D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 EARLIN AVE STE 290
BROWNS MILLS NJ
08015
US

IV. Provider business mailing address

6 EARLIN AVE STE 290
BROWNS MILLS NJ
08015-1780
US

V. Phone/Fax

Practice location:
  • Phone: 609-537-7200
  • Fax:
Mailing address:
  • Phone: 609-537-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS004744L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: