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General NPI Number Information
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NPI Number | 1619255288
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Entity Type | Organization
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Legal Business Name | PHOENIX ASSOCIATES LLC
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 07/29/2011
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Provider Practice Location Address
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Address Line | 1601 TILTON RD SUITE 4
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1877
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Country | US
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Telephone | 609-407-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 TILTON RD SUITE 4
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1877
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Country | US
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Telephone | 609-407-1119
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SCOTT ALAN HERNBERG
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Credential | D.O.
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Telephone | 609-407-1119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 25MB04215800
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License Number State | NJ
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