Healthcare Provider Details

I. General information

NPI: 1629006200
Provider Name (Legal Business Name): WESTFIELD AVENUE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 WESTFIELD AVE
CAMDEN NJ
08105-2412
US

IV. Provider business mailing address

PO BOX 1966
CAMDEN NJ
08101-1966
US

V. Phone/Fax

Practice location:
  • Phone: 856-963-0739
  • Fax:
Mailing address:
  • Phone: 856-963-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB52022
License Number StateNJ

VIII. Authorized Official

Name: MORRIS PETERZELL
Title or Position: PRESIDENT
Credential: D.O.
Phone: 856-963-0739