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General NPI Number Information
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NPI Number | 1972553642
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Entity Type | Organization
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Legal Business Name | MAINBRIDGE MEDICAL
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 MAINBRIDGE LN
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City | WILLINGBORO
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State | NJ
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Zip | 08046-2103
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Country | US
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Telephone | 609-877-0646
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Fax | 609-877-0370
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Provider Business Mailing Address
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Address Line | PO BOX 8627
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City | CHERRY HILL
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State | NJ
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Zip | 08002-0627
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Country | US
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Telephone | 856-755-1616
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Fax | 856-755-0098
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Authorized Official
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Title or Position | OWNER
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Name | LEONARD S KATZ
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Credential | D.O.
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Telephone | 609-877-0644
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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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