Healthcare Provider Details

I. General information

NPI: 1053640797
Provider Name (Legal Business Name): URBAN TREATMENT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 MARKET STREET
CAMDEN NJ
08102
US

IV. Provider business mailing address

808 MARKET STREET
CAMDEN NJ
08102
US

V. Phone/Fax

Practice location:
  • Phone: 856-225-0505
  • Fax: 856-541-0719
Mailing address:
  • Phone: 856-225-0505
  • Fax: 856-541-0719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number2000459-09
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN D HOTTSCLAW
Title or Position: BOARD PRESIDENT
Credential: M.D.
Phone: 856-225-0505