MEDICARE: ALLENTOWN MEDICAL ASSOCIATES

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
1	332900000X	Non-Pharmacy Dispensing Site	MA047072	NJ

General Provider Information

NPI Number	:	1487975777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLENTOWN MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	5810 NANCY RIDGE DR
Second Line	:	100
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 BURLINGTON PATH RD
Second Line	:	L
City	:	CREAM RIDGE
State	:	NJ
Zip	:	08514-1622
Country	:	US
Telephone Number	:	609-758-1100
Fax Number	:

Authorized Official
Title or Position	:	SR DIRECTOR OPERATIONS
Name	:	KENNY HEINE
Credential	:
Telephone Number	:	858-625-2990

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/21/2010

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