=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609924323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIABETES & ENDOCRINOLOGY ASSOCIATES, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1235 WHITEHORSE MERCERVILLE RD SUITE 301
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08619-3810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-581-7725
-----------------------------------------------------
Fax | 609-581-7726
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1235 WHITEHORSE MERCERVILLE RD SUITE 301
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08619-3810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-581-7725
-----------------------------------------------------
Fax | 609-581-7726
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | DIANE MUNDHENK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-581-7725
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------