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General NPI Number Information
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NPI Number | 1740848530
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Entity Type | Organization
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Legal Business Name | JEFFERSON HEALTH NEW JERSEY DIRECT PRIMARY CARE, P.C.
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 308 N HADDON AVE STE 308-1
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City | HADDONFIELD
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State | NJ
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Zip | 08033-1723
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Country | US
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Telephone | 856-883-5249
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Fax | 856-477-2539
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Provider Business Mailing Address
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Address Line | 308 N HADDON AVE STE 308-1
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City | HADDONFIELD
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State | NJ
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Zip | 08033-1723
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Country | US
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Telephone | 856-883-5249
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Fax | 856-477-2539
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Authorized Official
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Title or Position | MANAGING PHYSICIAN
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Name | DR. JOSEPH JAMES RUNFOLA
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Credential | MD
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Telephone | 856-883-5249
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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 |
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License Number State |
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