Provider Demographics
NPI:1477628485
Name:MOBILE WOUND CONSULTANTS
Entity Type:Organization
Organization Name:MOBILE WOUND CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:856-845-0500
Mailing Address - Street 1:127 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1718
Mailing Address - Country:US
Mailing Address - Phone:856-845-0500
Mailing Address - Fax:856-384-8757
Practice Address - Street 1:1900 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2304
Practice Address - Country:US
Practice Address - Phone:856-845-0500
Practice Address - Fax:856-384-8757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty