Healthcare Provider Details

I. General information

NPI: 1699701722
Provider Name (Legal Business Name): PHOENIX OB GYN ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MADISON AVE SUITE B
MOUNT HOLLY NJ
08060-2055
US

IV. Provider business mailing address

120 MADISON AVE SUITE B
MOUNT HOLLY NJ
08060-2055
US

V. Phone/Fax

Practice location:
  • Phone: 609-261-4925
  • Fax: 609-261-9362
Mailing address:
  • Phone: 609-261-4925
  • Fax: 609-261-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD TEDDY LEVINE
Title or Position: MANAGER
Credential: M.D.
Phone: 609-261-6701