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General NPI Number Information
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NPI Number | 1275036923
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Entity Type | Organization
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Legal Business Name | CARDIAC PREVENTIVE AND WELLNESS SERVICES OF SOUTH JERSEY LLC
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 03/08/2018
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Provider Practice Location Address
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Address Line | 1930 MARLTON PIKE E UNIT 1142
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2150
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Country | US
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Telephone | 856-446-6961
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 MARLTON PIKE E UNIT 1142
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2150
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Country | US
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Telephone | 856-446-6961
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW M COGAN
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Credential | DO
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Telephone | 609-707-9071
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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 | 25MB06500100
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License Number State | NJ
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