Healthcare Provider Details

I. General information

NPI: 1255985677
Provider Name (Legal Business Name): MULLICA HILL ADVANCED THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 MULLICA HILL RD
MULLICA HILL NJ
08062-2665
US

IV. Provider business mailing address

507 MULLICA HILL RD
MULLICA HILL NJ
08062-2665
US

V. Phone/Fax

Practice location:
  • Phone: 856-362-4819
  • Fax: 856-230-7171
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD PESCATORE
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 856-305-3863