Healthcare Provider Details

I. General information

NPI: 1427622661
Provider Name (Legal Business Name): TRABECULAR MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD STE 115
VOORHEES NJ
08043-4509
US

IV. Provider business mailing address

2301 E EVESHAM RD STE 115
VOORHEES NJ
08043-4509
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-5005
  • Fax: 856-770-8271
Mailing address:
  • Phone: 856-424-5005
  • Fax: 856-770-8271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES F HABERKERN
Title or Position: CEO
Credential:
Phone: 856-424-5005