Healthcare Provider Details

I. General information

NPI: 1821555376
Provider Name (Legal Business Name): EXECUTIVE CENTER FOR PSYCHOLOGICAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 WHITE HORSE RD STE C-101
VOORHEES NJ
08043-2494
US

IV. Provider business mailing address

701 WHITE HORSE RD STE C-101
VOORHEES NJ
08043-2494
US

V. Phone/Fax

Practice location:
  • Phone: 267-918-9672
  • Fax:
Mailing address:
  • Phone: 267-918-9672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: BABATUNDE ADETUNJI
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 267-918-9672