Healthcare Provider Details

I. General information

NPI: 1639554991
Provider Name (Legal Business Name): INSPIRA HEALTH MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N BROAD ST
WOODBURY NJ
08096-1617
US

IV. Provider business mailing address

2848 S DELSEA DR STE 4B
VINELAND NJ
08360-7042
US

V. Phone/Fax

Practice location:
  • Phone: 856-205-7070
  • Fax:
Mailing address:
  • Phone: 856-205-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberL9076
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA03874500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMT192156
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA06071600
License Number StateNJ

VIII. Authorized Official

Name: MR. ARUTHUR JAMES BOOTE
Title or Position: VP, AMBULATORY SERVICES
Credential:
Phone: 856-641-8627