Healthcare Provider Details

I. General information

NPI: 1033126958
Provider Name (Legal Business Name): EDMUND J DECKER DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 CHURCH ROAD
MT LAUREL NJ
08054
US

IV. Provider business mailing address

3820 CHURCH ROAD
MT LAUREL NJ
08054
US

V. Phone/Fax

Practice location:
  • Phone: 856-727-4774
  • Fax: 856-727-4715
Mailing address:
  • Phone: 856-727-4774
  • Fax: 856-727-4715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL A BODEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 856-727-4774