Healthcare Provider Details

I. General information

NPI: 1609673250
Provider Name (Legal Business Name): DANIELLE DEMBECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S PENNSVILLE AUBURN RD
PENNS GROVE NJ
08069-2936
US

IV. Provider business mailing address

500 S PENNSVILLE AUBURN RD
PENNS GROVE NJ
08069-2936
US

V. Phone/Fax

Practice location:
  • Phone: 856-299-3200
  • Fax: 856-485-8472
Mailing address:
  • Phone: 856-299-3200
  • Fax: 856-485-8472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NR12931900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: