Healthcare Provider Details

I. General information

NPI: 1114058773
Provider Name (Legal Business Name): TOWNSHIP OF DEPTFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 COOPER ST
WOODBURY NJ
08096-3076
US

IV. Provider business mailing address

PO BOX 1016
VOORHEES NJ
08043-7016
US

V. Phone/Fax

Practice location:
  • Phone: 856-686-2234
  • Fax:
Mailing address:
  • Phone: 856-784-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberDEPT00156
License Number StateNJ

VIII. Authorized Official

Name: MR. THOMAS E NEWMAN
Title or Position: DIRECTOR
Credential:
Phone: 856-686-2234