Healthcare Provider Details

I. General information

NPI: 1427076553
Provider Name (Legal Business Name): RANCOCAS ANESTHESIOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 MIDLANTIC DR
MOUNT LAUREL NJ
08054-1573
US

IV. Provider business mailing address

PO BOX 1568
MOUNT LAUREL NJ
08054-7568
US

V. Phone/Fax

Practice location:
  • Phone: 856-829-9345
  • Fax: 856-829-3605
Mailing address:
  • Phone: 856-829-9345
  • Fax: 856-829-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBERTA LYNNE CATULLO
Title or Position: COMPLIANCE OFFICER
Credential: R.N.
Phone: 856-829-9345