Healthcare Provider Details

I. General information

NPI: 1194489294
Provider Name (Legal Business Name): SCOTT ERIC HIRST JR. DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 COOPER RD
VOORHEES NJ
08043-3800
US

IV. Provider business mailing address

434 BETHEL MILL RD
SEWELL NJ
08080-4532
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-2224
  • Fax:
Mailing address:
  • Phone: 609-922-4825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number26NR19461500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ01231400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: