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General NPI Number Information
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NPI Number | 1174130835
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Entity Type | Organization
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Legal Business Name | DMM MEDICAL CONSULTING GROUP LLC
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 4551 ROUTE 42 STE 3
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-1751
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Country | US
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Telephone | 609-337-2211
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Fax | 609-543-2433
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Provider Business Mailing Address
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Address Line | 212 N ARTHUR DR
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City | EDGEWATER PARK
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State | NJ
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Zip | 08010-2102
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Country | US
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Telephone | 609-847-0538
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Fax | 609-543-2433
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MRS. DONNA MAZYCK
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Credential | APN
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Telephone | 609-847-0538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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