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General NPI Number Information
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NPI Number | 1174684781
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Entity Type | Organization
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Legal Business Name | SPRINGDALE ROAD MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2428 ROUTE 38 SUITE 306
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City | CHERRY HILL
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State | NJ
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Zip | 08002-1241
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Country | US
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Telephone | 856-348-8444
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Fax | 856-348-8446
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Provider Business Mailing Address
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Address Line | 2428 ROUTE 38 SUITE 306
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City | CHERRY HILL
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State | NJ
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Zip | 08002-1241
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Country | US
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Telephone | 856-348-8444
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Fax | 856-348-8446
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LAWRENCE S FORMAN
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Credential | DO
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Telephone | 856-348-8444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MB02310600
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License Number State | NJ
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