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General NPI Number Information
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NPI Number | 1629022264
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Entity Type | Organization
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Legal Business Name | ALLIED GASTROINTESTINAL ASSOCIATES, P.A.
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 217 WHITE HORSE PIKE
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City | HADDON HEIGHTS
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State | NJ
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Zip | 08035-1703
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Country | US
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Telephone | 856-547-1661
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Fax | 856-547-6117
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Provider Business Mailing Address
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Address Line | 217 WHITE HORSE PIKE
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City | HADDON HEIGHTS
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State | NJ
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Zip | 08035-1703
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Country | US
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Telephone | 856-547-1661
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Fax | 856-547-6117
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARY M VOLLMER
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Credential |
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Telephone | 856-547-1661
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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 | 25MB04369000
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License Number State | NJ
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