Provider Demographics
NPI:1013042936
Name:GEORGE J. PETRUNCIO, M.D., P.A.
Entity Type:Organization
Organization Name:GEORGE J. PETRUNCIO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PETRUNCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-875-7700
Mailing Address - Street 1:188 FRIES MILL RD
Mailing Address - Street 2:SUITE E-1
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2015
Mailing Address - Country:US
Mailing Address - Phone:856-875-7700
Mailing Address - Fax:856-262-0428
Practice Address - Street 1:188 FRIES MILL RD
Practice Address - Street 2:SUITE E-1
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2015
Practice Address - Country:US
Practice Address - Phone:856-875-7700
Practice Address - Fax:856-262-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty