Healthcare Provider Details

I. General information

NPI: 1417094228
Provider Name (Legal Business Name): DOMINGO F. MAGBALON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 BLUE JAY LN
CHERRY HILL NJ
08003-3102
US

IV. Provider business mailing address

1656 BLUE JAY LN
CHERRY HILL NJ
08003-3102
US

V. Phone/Fax

Practice location:
  • Phone: 856-428-2448
  • Fax:
Mailing address:
  • Phone: 856-428-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number34818
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: