Healthcare Provider Details

I. General information

NPI: 1629034905
Provider Name (Legal Business Name): ANTHONY JOSEPH ABBRUZZI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 BLACK HORSE PIKE STE 501
PLEASANTVILLE NJ
08232-2967
US

IV. Provider business mailing address

331 CHESTER AVE
MOORESTOWN NJ
08057-2525
US

V. Phone/Fax

Practice location:
  • Phone: 609-822-7979
  • Fax:
Mailing address:
  • Phone: 856-996-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number22443
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB09768400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS009203L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: