Healthcare Provider Details

I. General information

NPI: 1174711543
Provider Name (Legal Business Name): PENNS GROVE - CARNEYS POINT REG SCH DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 IONA AVE
PENNS GROVE NJ
08069-2057
US

IV. Provider business mailing address

100 IONA AVE
PENNS GROVE NJ
08069-2057
US

V. Phone/Fax

Practice location:
  • Phone: 856-299-4250
  • Fax: 856-299-5226
Mailing address:
  • Phone: 856-299-4250
  • Fax: 856-299-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH A. MASSARE
Title or Position: SUPERINTENDENT
Credential: E.D. D
Phone: 856-299-4250