Healthcare Provider Details

I. General information

NPI: 1992034037
Provider Name (Legal Business Name): BLABER CARDIOLOGY AT LOURDES MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRACE RD SUITE C
CHERRY HILL NJ
08034-2600
US

IV. Provider business mailing address

500 GROVE ST SUITE 100
HADDON HEIGHTS NJ
08035-1736
US

V. Phone/Fax

Practice location:
  • Phone: 856-796-9390
  • Fax: 856-796-9391
Mailing address:
  • Phone: 856-796-9200
  • Fax: 856-310-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA06214500
License Number StateNJ

VIII. Authorized Official

Name: STEVEN FOX
Title or Position: PRESIDENT
Credential: M. D.
Phone: 856-796-9200