Provider Demographics
NPI:1245397645
Name:MARLTON MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:MARLTON MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SHRAYBER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-429-3862
Mailing Address - Street 1:1305 KINGS HWY N
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1919
Mailing Address - Country:US
Mailing Address - Phone:856-429-3862
Mailing Address - Fax:856-429-3826
Practice Address - Street 1:1305 KINGS HWY N
Practice Address - Street 2:SUITE 4
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1919
Practice Address - Country:US
Practice Address - Phone:856-429-3862
Practice Address - Fax:856-429-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076715Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER