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General NPI Number Information
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NPI Number | 1932234432
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Entity Type | Individual
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Provider Name | BRIAN CAMPENELLA PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 600 SOMERDALE RD SUITE 113
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City | VOORHEES
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State | NJ
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Zip | 08043-1858
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Country | US
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Telephone | 856-795-1945
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Fax | 856-795-7472
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Provider Business Mailing Address
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Address Line | 600 SOMERDALE RD SUITE 113
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City | VOORHEES
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State | NJ
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Zip | 08043-1858
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Country | US
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Telephone | 856-795-1945
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Fax | 856-795-7472
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00131000
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License Number State | NJ
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