Healthcare Provider Details

I. General information

NPI: 1730285651
Provider Name (Legal Business Name): GREGORY H. SCIMECA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SUNSET RD
WILLINGBORO NJ
08046-1109
US

IV. Provider business mailing address

225 SUNSET RD
WILLINGBORO NJ
08046-1109
US

V. Phone/Fax

Practice location:
  • Phone: 609-877-2800
  • Fax: 609-877-1813
Mailing address:
  • Phone: 609-877-2800
  • Fax: 609-877-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA04848700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: