Healthcare Provider Details

I. General information

NPI: 1750470761
Provider Name (Legal Business Name): CORNERSTONE ASTHMA AND ALLERGY ASSOCIATES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 OLD MARLTON PIKE SUITE 211
MEDFORD NJ
08055-8772
US

IV. Provider business mailing address

103 OLD MARLTON PIKE MEDFORD MEDICAL CENTER SUITE 211
MEDFORD NJ
08055
US

V. Phone/Fax

Practice location:
  • Phone: 609-953-7500
  • Fax: 609-953-9085
Mailing address:
  • Phone: 609-953-7500
  • Fax: 609-953-9085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA48238
License Number StateNJ

VIII. Authorized Official

Name: DR. ERIC W. BANTZ
Title or Position: DR.
Credential: M.D.
Phone: 609-953-7500