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General NPI Number Information
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NPI Number | 1407836935
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Entity Type | Individual
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Provider Name | SANJEEV ATHALE MD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 12/02/2023
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Provider Practice Location Address
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Address Line | 1 COOPER PLZ
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City | CAMDEN
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State | NJ
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Zip | 08103-1461
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Country | US
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Telephone | 856-342-2380
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FEDERAL ST STE 200
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City | CAMDEN
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State | NJ
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Zip | 08103-1088
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Country | US
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Telephone | 482-886-9358
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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 | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | A114198
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | 233479
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA11615900
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License Number State | NJ
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