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General NPI Number Information
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NPI Number | 1568659670
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Entity Type | Organization
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Legal Business Name | PENN VALLEY ANESTHESIA ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 93 COOPER RD SUITE 100
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City | VOORHEES
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State | NJ
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Zip | 08043-4910
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Country | US
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Telephone | 856-770-1950
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 WHITE HORSE RD STE 612
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City | VOORHEES
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State | NJ
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Zip | 08043-4412
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Country | US
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Telephone | 856-451-3552
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ROBERT HAWK
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Credential | CRNA
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Telephone | 856-451-3552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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