Healthcare Provider Details

I. General information

NPI: 1033149851
Provider Name (Legal Business Name): UPPER DEERFIELD TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOOVER RD
SEABROOK NJ
08302
US

IV. Provider business mailing address

PO BOX 5038
SEABROOK NJ
08302-5038
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-2779
  • Fax:
Mailing address:
  • Phone: 856-455-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. ROY SPOLTORE
Title or Position: ADMINISTRATOR
Credential:
Phone: 856-455-7348