Provider Demographics
NPI:1477148252
Name:PEACH ASSISTANCE PROGRAM
Entity Type:Organization
Organization Name:PEACH ASSISTANCE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALLEN FUNDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL CONSULTANT
Authorized Official - Phone:856-822-0453
Mailing Address - Street 1:1172 TRISTRAM CIR
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-2205
Mailing Address - Country:US
Mailing Address - Phone:856-822-0453
Mailing Address - Fax:856-539-5820
Practice Address - Street 1:1172 TRISTRAM CIR
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:NJ
Practice Address - Zip Code:08051-2205
Practice Address - Country:US
Practice Address - Phone:856-822-0453
Practice Address - Fax:856-539-5820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable