1174646095 NPI number — DELAWARE VALLEY MEDICAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174646095 NPI number — DELAWARE VALLEY MEDICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELAWARE VALLEY MEDICAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174646095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8697
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLINGSWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08108-8697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-665-5100
Provider Business Mailing Address Fax Number:
856-665-5212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7980 S CRESCENT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENNSAUKEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08109-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-665-5100
Provider Business Practice Location Address Fax Number:
856-665-5212
Provider Enumeration Date:
04/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VOORHIS
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
856-665-5100

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X , with the licence number:  2000015 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0092843 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8847266 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com