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General NPI Number Information
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NPI Number | 1477148252
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Entity Type | Organization
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Legal Business Name | PEACH ASSISTANCE PROGRAM
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 1172 TRISTRAM CIR
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City | MANTUA
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State | NJ
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Zip | 08051-2205
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Country | US
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Telephone | 856-822-0453
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Fax | 856-539-5820
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Provider Business Mailing Address
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Address Line | 1172 TRISTRAM CIR
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City | MANTUA
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State | NJ
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Zip | 08051-2205
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Country | US
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Telephone | 856-822-0453
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Fax | 856-539-5820
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALLISON G ALLEN FUNDENBERG
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Credential | MEDICAL CONSULTANT
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Telephone | 856-822-0453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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