Healthcare Provider Details

I. General information

NPI: 1972673713
Provider Name (Legal Business Name): HAND SURGERY & REHABILITATION CENTER OF NEW JERSEY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SAGEMORE DR SUITE 103
MARLTON NJ
08053-4307
US

IV. Provider business mailing address

5000 SAGEMORE DRIVE SUITE 103
MARLTON NJ
08053
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-4263
  • Fax: 856-983-0674
Mailing address:
  • Phone: 856-983-4263
  • Fax: 856-983-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number24019
License Number StateNJ

VIII. Authorized Official

Name: FREDERICK L. BALLET
Title or Position: PRESIDENT
Credential: M.D.
Phone: 856-983-4263