MEDICARE: HOLY REDEEMER HOUSE CALLS OF NJ PC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1932446333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLY REDEEMER HOUSE CALLS OF NJ PC

Provider Business Mailing Address
First Line	:	667 WELSH RD
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-6309
Country	:	US
Telephone Number	:	215-938-4661
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 DELILAH RD
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-5102
Country	:	US
Telephone Number	:	215-938-4661
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	ANTHONY COLETTA
Credential	:	M.D.
Telephone Number	:	215-938-4661

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	01/07/2013

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