Healthcare Provider Details

I. General information

NPI: 1750387718
Provider Name (Legal Business Name): DAVID LEE SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 RAMBLEWOOD RD
MOORESTOWN NJ
08057-2628
US

IV. Provider business mailing address

108 RAMBLEWOOD RD
MOORESTOWN NJ
08057-2628
US

V. Phone/Fax

Practice location:
  • Phone: 856-296-9407
  • Fax: 856-727-9337
Mailing address:
  • Phone: 856-296-9407
  • Fax: 856-727-9337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD025294E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA04403100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: