Healthcare Provider Details

I. General information

NPI: 1174576896
Provider Name (Legal Business Name): PHYSICIAN MANAGEMENT, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W SHERMAN AVE
VINELAND NJ
08360-6912
US

IV. Provider business mailing address

7900 WISCONSIN AVE SUITE 406
BETHESDA MD
20814-3601
US

V. Phone/Fax

Practice location:
  • Phone: 856-641-8000
  • Fax:
Mailing address:
  • Phone: 301-652-2707
  • Fax: 301-907-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH S FASTOW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-652-2707