Healthcare Provider Details

I. General information

NPI: 1396850228
Provider Name (Legal Business Name): AFFILIATED PHYSICIANS NETWORK, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 MANTUA PIKE
WOODBURY HEIGHTS NJ
08097-1149
US

IV. Provider business mailing address

740 MANTUA PIKE
WOODBURY HEIGHTS NJ
08097-1149
US

V. Phone/Fax

Practice location:
  • Phone: 856-845-0360
  • Fax: 856-845-1881
Mailing address:
  • Phone: 856-845-0360
  • Fax: 856-845-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00269500
License Number StateNJ

VIII. Authorized Official

Name: MR. TIMOTHY LEONARD PROBE
Title or Position: CEO
Credential: DC
Phone: 856-845-0360