Provider Demographics
NPI:1114220142
Name:STRAHLE, SCOTT (GNP)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:STRAHLE
Suffix:
Gender:M
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S BLACK HORSE PIKE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2975
Mailing Address - Country:US
Mailing Address - Phone:856-292-8216
Mailing Address - Fax:856-848-3011
Practice Address - Street 1:141 S BLACK HORSE PIKE
Practice Address - Street 2:SUITE 104
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2975
Practice Address - Country:US
Practice Address - Phone:856-292-8216
Practice Address - Fax:856-848-3011
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00298700363LG0600X
PASP010888363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology