Healthcare Provider Details

I. General information

NPI: 1053425090
Provider Name (Legal Business Name): MID-NJ GYNECOLOGICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 KINGS HWY N SUITE 100
CHERRY HILL NJ
08034-1502
US

IV. Provider business mailing address

601 CHAPEL AVE E
CHERRY HILL NJ
08034-1454
US

V. Phone/Fax

Practice location:
  • Phone: 856-667-5910
  • Fax:
Mailing address:
  • Phone: 856-356-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: ANNE GRIFFIN
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 856-356-4025