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General NPI Number Information
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NPI Number | 1568614253
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Entity Type | Organization
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Legal Business Name | CORNWALL POLYCLINIC, L.L.C.
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 3 CORNWALL DR
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3311
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Country | US
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Telephone | 732-698-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 3 CORNWALL DR
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3311
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Country | US
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Telephone | 732-698-0700
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BENJAMIN LEVINE
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Credential | M.D.
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Telephone | 732-698-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | MA023897
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License Number State | NJ
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