Healthcare Provider Details

I. General information

NPI: 1245285196
Provider Name (Legal Business Name): DELRAN FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 ROUTE 130 SUITE 120
DELRAN NJ
08075-1869
US

IV. Provider business mailing address

8008 ROUTE 130 SUITE 120
DELRAN NJ
08075-1869
US

V. Phone/Fax

Practice location:
  • Phone: 856-764-7997
  • Fax: 856-764-1840
Mailing address:
  • Phone: 856-764-7997
  • Fax: 856-764-1840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: ANN NUTTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 856-764-7997