Healthcare Provider Details

I. General information

NPI: 1558332957
Provider Name (Legal Business Name): KAMALDEEP SINGH MOMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CHURCH RD
MOUNT LAUREL NJ
08054-1110
US

IV. Provider business mailing address

4000 CHURCH RD
MOUNT LAUREL NJ
08054-1110
US

V. Phone/Fax

Practice location:
  • Phone: 856-222-4444
  • Fax: 856-222-4733
Mailing address:
  • Phone: 856-222-4444
  • Fax: 856-222-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number25MA06542800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: