MEDICARE: AUTONOMIC CLINICAL SERVICES

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	207Q00000X	Family Medicine Physician	25MB05189200-NJ	NJ

General Provider Information

NPI Number	:	1609070465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTONOMIC CLINICAL SERVICES

Provider Business Mailing Address
First Line	:	813 E GATE DR STE B
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-1238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 E GATE DR STE B
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-1238
Country	:	US
Telephone Number	:	856-222-9916
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRUCE A NAYLOR
Credential	:	PHD
Telephone Number	:	856-222-9916

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	08/22/2020

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