Healthcare Provider Details

I. General information

NPI: 1770774481
Provider Name (Legal Business Name): CMC DEPARTMENT OF MEDCINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ SUITE 215 (NEUROLOGY)
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

3 COOPER PLZ SUITE 502
CAMDEN NJ
08103-1438
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2445
  • Fax: 856-964-0504
Mailing address:
  • Phone: 856-342-2921
  • Fax: 856-968-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT MCMULLEN
Title or Position: EVP MANAGED CARE
Credential:
Phone: 856-342-2921