Healthcare Provider Details

I. General information

NPI: 1598803793
Provider Name (Legal Business Name): ENDOCRINE ASSOCIATES OF SOUTH JERSEY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 E MAIN ST
MOORESTOWN NJ
08057
US

IV. Provider business mailing address

703 E MAIN ST
MOORESTOWN NJ
08057
US

V. Phone/Fax

Practice location:
  • Phone: 856-727-0900
  • Fax: 856-231-8428
Mailing address:
  • Phone: 856-727-0900
  • Fax: 856-231-8428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY EMILY POPILOCK
Title or Position: OFFICE MANAGER
Credential:
Phone: 856-727-0900