Healthcare Provider Details

I. General information

NPI: 1710271895
Provider Name (Legal Business Name): THEODORE JAMES PLUSH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLZ
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

134 BRIDGETON PIKE
MULLICA HILL NJ
08062-2616
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2633
  • Fax:
Mailing address:
  • Phone: 856-507-2783
  • Fax: 856-221-4138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS016851
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MB10340700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS016851
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: