Src Pending Consult Management | |
5250 Maryland Ave Fort Dix NJ 08640-5058 | |
(609) 562-6312 | |
Not Available |
Full Name | Src Pending Consult Management |
---|---|
Speciality | Clinic/center |
Location | 5250 Maryland Ave, Fort Dix, New Jersey |
Authorized Official Name and Position | Christala Cherry (CASE MANAGER) |
Authorized Official Contact | 6095626312 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Src Pending Consult Management 1312 Paris Ct Lakewood NJ 08701-3724 Ph: (732) 267-7737 | Src Pending Consult Management 5250 Maryland Ave Fort Dix NJ 08640-5058 Ph: (609) 562-6312 |
NPI Number | 1366433534 |
---|---|
Provider Enumeration Date | 11/04/2005 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366433534 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 26NR09534400 (New Jersey) | Primary |