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General NPI Number Information
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NPI Number | 1770457491
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Entity Type | Organization
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Legal Business Name | MARLTON PIKE EAST MEDICAL LLC
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Dates
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Enumeration Date | 10/04/2025
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Last Update Date | 10/04/2025
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Provider Practice Location Address
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Address Line | 1930 MARLTON PIKE E STE F34
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City | CHERRY HILL
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State | NJ
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Zip | 08003-4103
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Country | US
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Telephone | 856-348-3700
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Fax | 856-348-3999
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Provider Business Mailing Address
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Address Line | 1930 MARLTON PIKE E STE F34
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City | CHERRY HILL
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State | NJ
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Zip | 08003-4103
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Country | US
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Telephone | 856-348-3700
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Fax | 856-348-3999
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LUIS SANTOS
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Credential | MD
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Telephone | 856-348-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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