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General NPI Number Information
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NPI Number | 1659372910
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Entity Type | Individual
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Provider Name | GREGORY MUKALIAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 1113 HOSPITAL DR STE 100A
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City | WILLINGBORO
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State | NJ
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Zip | 08046-1128
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Country | US
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Telephone | 609-835-5821
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Fax | 609-835-5827
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Provider Business Mailing Address
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Address Line | 301 LIPPINCOTT DR STE 410
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City | MARLTON
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State | NJ
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Zip | 08053-4197
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Country | US
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Telephone | 856-355-0340
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Fax | 856-355-0330
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MB06369000
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License Number State | NJ
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