Healthcare Provider Details

I. General information

NPI: 1245722164
Provider Name (Legal Business Name): JEFFREY ADAM FEHDER APN-CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAPITAL HEALTH MEDICAL CENTER - HOPEWELL 1 CAPITAL WAY - SECOND FLOOR, ANESTHESIA OFFICES
PENNINGTON NJ
08534
US

IV. Provider business mailing address

1 HIGHGATE CT
CHERRY HILL NJ
08003-1811
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-4700
  • Fax: 954-616-3877
Mailing address:
  • Phone: 917-912-8345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00825900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: