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General NPI Number Information
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NPI Number | 1801566336
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Entity Type | Organization
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Legal Business Name | NORTHEAST INSTITUTE FOR AGE MANAGEMENT
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 401 NEW RD STE 103
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City | LINWOOD
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State | NJ
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Zip | 08221-1200
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Country | US
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Telephone | 609-232-7037
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Fax |
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Provider Business Mailing Address
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Address Line | 401 NEW RD STE 103
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City | LINWOOD
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State | NJ
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Zip | 08221-1200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | FREDERICK COVILLE
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Credential | MD
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Telephone | 609-232-7037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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