Healthcare Provider Details

I. General information

NPI: 1962811182
Provider Name (Legal Business Name): PLOVER INPATIENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CORLIES AVE ROUTE 33
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

PO BOX 38024
PHILADELPHIA PA
19101-0706
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN VAUGHN
Title or Position: OFFICER
Credential:
Phone: 404-450-4684