Healthcare Provider Details

I. General information

NPI: 1972583060
Provider Name (Legal Business Name): DR. ROBERT E HUDRICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTURY PKWY STE 140
MOUNT LAUREL NJ
08054-1149
US

IV. Provider business mailing address

100 CENTURY PKWY STE 140
MOUNT LAUREL NJ
08054-1149
US

V. Phone/Fax

Practice location:
  • Phone: 856-380-2400
  • Fax: 856-234-7870
Mailing address:
  • Phone: 856-380-2400
  • Fax: 856-234-7870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB06110900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: