Healthcare Provider Details

I. General information

NPI: 1134115074
Provider Name (Legal Business Name): BURLINGTON COUNTY OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SALEM RD SUITE B
WILLINGBORO NJ
08046-2852
US

IV. Provider business mailing address

1000 SALEM RD SUITE B
WILLINGBORO NJ
08046-2852
US

V. Phone/Fax

Practice location:
  • Phone: 609-871-2060
  • Fax: 609-871-3535
Mailing address:
  • Phone: 609-871-2060
  • Fax: 609-871-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL D HORN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 609-871-2060