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General NPI Number Information
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NPI Number | 1215369772
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Entity Type | Individual
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Provider Name | AMRITA A PHADNIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 113 SOUTH ROUTE 73 POWERBACK VOORHEES
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City | VOORHEES
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State | NJ
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Zip | 08043
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Country | US
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Telephone | 856-809-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 9 GLORIA LN
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City | MONROE
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State | NJ
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Zip | 08831-0168
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Country | US
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Telephone | 507-358-1932
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00137800
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License Number State | NJ
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