Provider Demographics
NPI:1689767139
Name:TURNERSVILLE INTERNAL MEDICINE AND GERIATRICS
Entity Type:Organization
Organization Name:TURNERSVILLE INTERNAL MEDICINE AND GERIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDULGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-740-9777
Mailing Address - Street 1:4991 ROUTE 42 STE 8
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1750
Mailing Address - Country:US
Mailing Address - Phone:856-740-9777
Mailing Address - Fax:856-740-9990
Practice Address - Street 1:4991 ROUTE 42 STE 8
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1750
Practice Address - Country:US
Practice Address - Phone:856-740-9777
Practice Address - Fax:856-740-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA077749261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0061182Medicaid
NJ0061182Medicaid