Healthcare Provider Details

I. General information

NPI: 1053365973
Provider Name (Legal Business Name): ON-SITE SPECIALTY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E EVESHAM RD ON-SITE SPECIALTY CARE-CRNP
VOORHEES NJ
08043-9547
US

IV. Provider business mailing address

15 EAST NEW CASTLE ROAD
OCEAN CITY NJ
08226-4725
US

V. Phone/Fax

Practice location:
  • Phone: 610-613-9614
  • Fax: 253-663-7737
Mailing address:
  • Phone: 609-602-2908
  • Fax: 856-231-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FLORIA PETILLO
Title or Position: PARTNER
Credential: CRNP
Phone: 610-613-9614