MEDICARE: NEW LIFE MEDICAL DETOXIFICATION 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
1	2083A0300X	Addiction Medicine (Preventive Medicine) Physician
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1912466459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE MEDICAL DETOXIFICATION LLC

Provider Business Mailing Address
First Line	:	773 ROUTE 70 EAST
Second Line	:	SUITE E100
City	:	MARLTON
State	:	NJ
Zip	:	08053-4128
Country	:	US
Telephone Number	:	856-942-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	773 ROUTE 70 EAST
Second Line	:	SUITE E100
City	:	MARLTON
State	:	NJ
Zip	:	08053-4128
Country	:	US
Telephone Number	:	856-942-3700
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JOSEPH J SAVON
Credential	:	M.D.
Telephone Number	:	609-668-2503

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	01/17/2020

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