Healthcare Provider Details

I. General information

NPI: 1750576260
Provider Name (Legal Business Name): MERCER PRACTICE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 ROUTE 33 LEXINGTON SQUARE COMMONS
HAMILTON NJ
08690-1740
US

IV. Provider business mailing address

2131 ROUTE 33 LEXINGTON SQUARE COMMONS
HAMILTON NJ
08690-1740
US

V. Phone/Fax

Practice location:
  • Phone: 609-586-8499
  • Fax: 609-585-4902
Mailing address:
  • Phone: 609-586-8499
  • Fax: 609-585-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNMARIE ANGELO
Title or Position: MANAGER
Credential:
Phone: 609-586-8499