Healthcare Provider Details

I. General information

NPI: 1225023302
Provider Name (Legal Business Name): JOSEPH OMBALSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HADDON AVE
CAMDEN NJ
08103-3101
US

IV. Provider business mailing address

500 GROVE ST SUITE 100
HADDON HEIGHTS NJ
08035-1761
US

V. Phone/Fax

Practice location:
  • Phone: 856-757-3700
  • Fax: 856-365-7972
Mailing address:
  • Phone: 856-796-9200
  • Fax: 856-796-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA07108200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: