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NPI Code Detail

MEDICARE: DR. DAVID L NEIDORF MD

MEDICARE: DR. DAVID L NEIDORF MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician25MA04393800NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053334227
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID L NEIDORF MD
Provider Business Mailing Address
First Line : 301 LIPPINCOTT DR STE 410
Second Line :
City : MARLTON
State : NJ
Zip : 08053-4197
Country : US
Telephone Number : 856-355-0340
Fax Number : 856-355-0330
Provider Business Practice Location Address
First Line : 406 E GIBBSBORO RD FRNT
Second Line :
City : LINDENWOLD
State : NJ
Zip : 08021-1907
Country : US
Telephone Number : 856-309-0100
Fax Number : 856-309-8827
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 11/02/2020

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