Healthcare Provider Details

I. General information

NPI: 1366980088
Provider Name (Legal Business Name): DARIO ASTACIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ROUTE 70 E BLDG A
MARLTON NJ
08053-2341
US

IV. Provider business mailing address

765 ROUTE 70 E BLDG A
MARLTON NJ
08053-2341
US

V. Phone/Fax

Practice location:
  • Phone: 856-797-4721
  • Fax: 856-797-4785
Mailing address:
  • Phone: 856-797-4721
  • Fax: 856-797-4785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP05063
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA12407700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: