Healthcare Provider Details

I. General information

NPI: 1235384405
Provider Name (Legal Business Name): JOAN C WILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 HURFFVILLE CROSS KEYS RD
TURNERSVILLE NJ
08012-2453
US

IV. Provider business mailing address

151 FRIES MILL RD SUITE 301
TURNERSVILLE NJ
08012-2016
US

V. Phone/Fax

Practice location:
  • Phone: 856-513-4124
  • Fax: 856-302-5932
Mailing address:
  • Phone: 856-513-4224
  • Fax: 856-302-5932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MB08843200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MB08843200
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB08843200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: