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General NPI Number Information
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NPI Number | 1659446169
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Entity Type | Organization
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Legal Business Name | DELAWARE VALLEY PHYSICIANS & SURGEONS
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 559 MANTUA AVE
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City | PAULSBORO
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State | NJ
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Zip | 08066
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Country | US
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Telephone | 856-423-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 559 MANTUA AVE
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City | PAULSBORO
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State | NJ
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Zip | 08066-1178
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Country | US
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Telephone | 856-423-4500
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BRENDA L FERDIG
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Credential |
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Telephone | 856-423-4500
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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 | 25MA04703400
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License Number State | NJ
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