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General NPI Number Information
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NPI Number | 1497075527
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Entity Type | Organization
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Legal Business Name | MILLVILLE INTERNAL AND SPECIALTY MEDICINE LLC
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 608 N HIGH ST
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City | MILLVILLE
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State | NJ
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Zip | 08332-3025
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Country | US
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Telephone | 856-825-8080
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Fax | 856-327-8571
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Provider Business Mailing Address
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Address Line | 608 N HIGH ST
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City | MILLVILLE
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State | NJ
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Zip | 08332-3025
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Country | US
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Telephone | 856-825-8080
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Fax | 856-327-8571
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. RAVI HAJEEBU
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Credential |
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Telephone | 215-768-2265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 26MA08374000
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA07827400
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License Number State | NJ
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