Healthcare Provider Details

I. General information

NPI: 1366097172
Provider Name (Legal Business Name): MULLICA HILL ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 MULLICA HILL RD BLDG B
MULLICA HILL NJ
08062-2655
US

IV. Provider business mailing address

PO BOX 1029
MULLICA HILL NJ
08062-1029
US

V. Phone/Fax

Practice location:
  • Phone: 856-362-8898
  • Fax:
Mailing address:
  • Phone: 609-841-3049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GLENN DRAGON
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 609-841-3049