Healthcare Provider Details

I. General information

NPI: 1659446169
Provider Name (Legal Business Name): DELAWARE VALLEY PHYSICIANS & SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 MANTUA AVE
PAULSBORO NJ
08066
US

IV. Provider business mailing address

559 MANTUA AVE
PAULSBORO NJ
08066-1178
US

V. Phone/Fax

Practice location:
  • Phone: 856-423-4500
  • Fax:
Mailing address:
  • Phone: 856-423-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA04703400
License Number StateNJ

VIII. Authorized Official

Name: BRENDA L FERDIG
Title or Position: OFFICE MANAGER
Credential:
Phone: 856-423-4500