Provider Demographics
NPI:1881837052
Name:BOXER GOLDFARB, ELLEN M (CRNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:BOXER GOLDFARB
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:M
Other - Last Name:GOLDFARB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:732-790-0107
Practice Address - Street 1:460 E. GIBBSBORO ROAD, FRONT
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021
Practice Address - Country:US
Practice Address - Phone:856-390-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25NJ00288600363L00000X, 363LF0000X
PASP008082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091654Medicare PIN