Provider Demographics
NPI:1710470588
Name:BATES, TYPHANIE
Entity Type:Individual
Prefix:
First Name:TYPHANIE
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NEPTUNE DR N
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2126
Mailing Address - Country:US
Mailing Address - Phone:856-582-3900
Mailing Address - Fax:
Practice Address - Street 1:1 NEPTUNE DR N
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2126
Practice Address - Country:US
Practice Address - Phone:856-582-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health