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General NPI Number Information
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NPI Number | 1295097426
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Entity Type | Organization
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Legal Business Name | SYNERGY JOINT & SPINE LLC
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 525 ROUTE 73 S STE 300
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City | MARLTON
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State | NJ
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Zip | 08053-9644
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Country | US
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Telephone | 856-267-5319
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Fax | 856-267-5483
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Provider Business Mailing Address
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Address Line | 525 ROUTE 73 S STE 300
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City | MARLTON
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State | NJ
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Zip | 08053-9644
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Country | US
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Telephone | 856-267-5319
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Fax | 856-267-5483
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Authorized Official
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Title or Position | OWNER
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Name | ANDRE HU
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Credential | MD
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Telephone | 856-267-5319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 25MA07631700
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License Number State | NJ
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