Healthcare Provider Details

I. General information

NPI: 1942534243
Provider Name (Legal Business Name): OLLMC NEONATAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FRONT ST
ELMER NJ
08318-2101
US

IV. Provider business mailing address

1600 HADDON AVE ICN
CAMDEN NJ
08103-3101
US

V. Phone/Fax

Practice location:
  • Phone: 856-363-1000
  • Fax:
Mailing address:
  • Phone: 856-757-3988
  • Fax: 856-365-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25MA03693600
License Number StateNJ

VIII. Authorized Official

Name: MARGARET FERNANDES
Title or Position: MEDICAL DIRECTOR
Credential: M. D.
Phone: 856-757-3988