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NPI Code Detail

MEDICARE: THE FALL PREVENTION GROUP, LLC

MEDICARE: THE FALL PREVENTION GROUP, LLC
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
1363LG0600XGerontology Nurse Practitioner

General Provider Information

NPI Number : 1134529118
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE FALL PREVENTION GROUP, LLC
Provider Business Mailing Address
First Line : 230 N MAPLE AVE STE B1
Second Line : # 284
City : MARLTON
State : NJ
Zip : 08053-9412
Country : US
Telephone Number : 609-790-2327
Fax Number :
Provider Business Practice Location Address
First Line : 4401 HAVERFORD AVE # 19104
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-1332
Country : US
Telephone Number : 215-349-8800
Fax Number :
Authorized Official
Title or Position : CEO/ADMINISTRATOR
Name : DR. DEANNA L. GRAY-MICELI
Credential : PHD, GNP-BC
Telephone Number : 609-790-2327
Provider Enumeration Date : 08/27/2014
Last Update Date : 08/27/2014

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