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General NPI Number Information
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NPI Number | 1306594163
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Entity Type | Organization
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Legal Business Name | ETERNALLY ACP PC
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Dates
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Enumeration Date | 03/11/2022
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 693 MAIN ST STE D
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City | LUMBERTON
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State | NJ
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Zip | 08048-5043
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Country | US
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Telephone | 267-764-4704
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Fax |
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Provider Business Mailing Address
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Address Line | 104 FORREST AVE APT 3
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City | NARBERTH
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State | PA
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Zip | 19072-2215
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Country | US
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Telephone | 267-764-4704
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAYANK MATHUR
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Credential | MD
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Telephone | 267-764-4704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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