Provider Demographics
NPI:1235334814
Name:MOTE, MARIAN W (CPNP)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:W
Last Name:MOTE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BROADACRE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4705
Mailing Address - Country:US
Mailing Address - Phone:856-234-1031
Mailing Address - Fax:856-665-6907
Practice Address - Street 1:MERCHANTVILLE PEDIATRICS- A DIVISION OF CHA
Practice Address - Street 2:1 S. CENTRE STREET, SUITE 100
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109
Practice Address - Country:US
Practice Address - Phone:856-665-7337
Practice Address - Fax:856-665-3938
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05232700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NN05232700OtherNJ WITH PERSCRIPTIVE AUTH
NJMM0567909OtherDEA