| 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 |