Healthcare Provider Details

I. General information

NPI: 1689203945
Provider Name (Legal Business Name): GRACE NOOR NESHEIWAT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOWMAN DR STE E355
VOORHEES NJ
08043-9643
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-247-7210
  • Fax: 856-247-7511
Mailing address:
  • Phone: 856-247-7210
  • Fax: 856-247-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB12648800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: