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432 Ganttown Rd Ste 103 Sewell NJ 08080-1895 | |
| (856) 965-1000 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 432 Ganttown Rd Ste 103, Sewell, New Jersey |
| Authorized Official Name and Position | Rafia Nicola Grooms (OWNER) |
| Authorized Official Contact | 8569561000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
521 Sicklerville Rd Ste 3 Sicklerville NJ 08081-2636 Ph: (856) 956-1000 | 432 Ganttown Rd Ste 103 Sewell NJ 08080-1895 Ph: (856) 965-1000 |
| NPI Number | 1023797420 |
|---|---|
| Provider Enumeration Date | 07/13/2023 |
| Last Update Date | 01/09/2025 |
| Certification Date | 01/09/2025 |
| Medicare PECOS PAC ID | 3476084583 |
|---|---|
| Medicare Enrollment ID | O20240930004172 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023797420 | NPI | - | NPPES |
| Provider Name | Rafia Nicola Grooms |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043712003 PECOS PAC ID: 9739436239 Enrollment ID: I20181220001959 |
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