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General NPI Number Information
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NPI Number | 1699213165
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Entity Type | Organization
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Legal Business Name | VOORHEES MEDICAL HOME
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Dates
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Enumeration Date | 02/05/2017
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Last Update Date | 02/05/2017
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Provider Practice Location Address
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Address Line | 100 ROUTE 73
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City | VOORHEES
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State | NJ
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Zip | 08043-9575
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Country | US
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Telephone | 856-753-7374
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Fax | 856-753-1137
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Provider Business Mailing Address
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Address Line | 100 ROUTE 73
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City | VOORHEES
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State | NJ
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Zip | 08043-9575
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Country | US
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Telephone | 856-753-7374
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Fax | 856-753-1137
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. SHAHRAM JAY MIRMANESH
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Credential | MD
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Telephone | 609-238-0870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA06842200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA09469200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA09026400
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License Number State | NJ
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