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General NPI Number Information
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NPI Number | 1528109428
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Entity Type | Organization
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Legal Business Name | PENNSWOOD VILLAGE
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 309 BRIDGEBORO RD
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City | MOORESTOWN
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State | NJ
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Zip | 08057-1419
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Country | US
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Telephone | 856-439-2071
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Fax | 856-600-6550
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Provider Business Mailing Address
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Address Line | 309 BRIDGEBORO RD
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City | MOORESTOWN
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State | NJ
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Zip | 08057-1419
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Country | US
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Telephone | 856-439-2071
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Fax | 856-600-6550
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL GRIFFIN
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Credential |
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Telephone | 215-504-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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