Healthcare Provider Details

I. General information

NPI: 1023676426
Provider Name (Legal Business Name): DDK GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 VREELAND DR STE 106
SKILLMAN NJ
08558-2620
US

IV. Provider business mailing address

3553 W CHESTER PIKE STE 139
NEWTOWN SQUARE PA
19073-3701
US

V. Phone/Fax

Practice location:
  • Phone: 844-247-7894
  • Fax: 914-470-5056
Mailing address:
  • Phone: 484-424-7789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID GOLDSTEIN
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 914-376-6100