Healthcare Provider Details

I. General information

NPI: 1063573616
Provider Name (Legal Business Name): EDUARDO FRANCISCO ENRIQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BRENDENWOOD DR
VOORHEES NJ
08043-1603
US

IV. Provider business mailing address

1415 MARLTON PIKE E STE LL5
CHERRY HILL NJ
08034-2229
US

V. Phone/Fax

Practice location:
  • Phone: 856-874-0202
  • Fax: 856-874-0220
Mailing address:
  • Phone: 856-285-7200
  • Fax: 856-285-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA05198500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: