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General NPI Number Information
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NPI Number | 1215960752
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Entity Type | Organization
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Legal Business Name | GARDEN STATE MEDICAL ASSOC P A
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 100 BRICK RD SUITE 209
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City | MARLTON
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State | NJ
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Zip | 08053-2146
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Country | US
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Telephone | 856-983-2848
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Fax | 856-985-7645
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Provider Business Mailing Address
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Address Line | 100 BRICK RD SUITE 209
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City | MARLTON
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State | NJ
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Zip | 08053-2146
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Country | US
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Telephone | 856-983-2848
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Fax | 856-985-7645
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. JESSE VITO LOMONACO
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Credential | D.O.
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Telephone | 856-983-2848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State | NJ
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