Healthcare Provider Details

I. General information

NPI: 1659433357
Provider Name (Legal Business Name): ALLENTOWN MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 BURLINGTON PATH RD CREAM RIDGE PROFESSIONAL CENTER UNIT L
CREAM RIDGE NJ
08514-1622
US

IV. Provider business mailing address

163 BURLINGTON PATH RD CREAM RIDGE PROFESSIONAL CENTER UNIT L
CREAM RIDGE NJ
08514-1622
US

V. Phone/Fax

Practice location:
  • Phone: 609-758-1100
  • Fax: 609-758-3188
Mailing address:
  • Phone: 609-758-1100
  • Fax: 609-758-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA47072
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA47072
License Number StateNJ

VIII. Authorized Official

Name: DR. ALICIA SUE PELLER
Title or Position: COOWNER
Credential: M.D.
Phone: 609-758-1100