Healthcare Provider Details

I. General information

NPI: 1669998167
Provider Name (Legal Business Name): MARK GRIFFIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LIPPINCOTT DR
MARLTON NJ
08053-4802
US

IV. Provider business mailing address

224 STRAWBRIDGE DR STE 100
MOORESTOWN NJ
08057-4602
US

V. Phone/Fax

Practice location:
  • Phone: 856-334-4100
  • Fax: 856-334-4015
Mailing address:
  • Phone: 856-677-4000
  • Fax: 856-234-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number40QA01739300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: