Healthcare Provider Details

I. General information

NPI: 1922177856
Provider Name (Legal Business Name): INSPIRA HEALTH NETWORK MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 12/22/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 DELSEA DR N
GLASSBORO NJ
08028-1444
US

IV. Provider business mailing address

1120 DELSEA DR N
GLASSBORO NJ
08028-1444
US

V. Phone/Fax

Practice location:
  • Phone: 856-507-2783
  • Fax: 856-205-0145
Mailing address:
  • Phone: 856-507-2783
  • Fax: 856-205-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: JAMES THOMAS O'CONNELL
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 856-575-4777