Provider Demographics
NPI:1891020996
Name:ASSOCIATES IN PREVENTIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:ASSOCIATES IN PREVENTIVE MEDICINE, LLC
Other - Org Name:CHERRYHILL CLINIC FOR PREVENTIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FANTASIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-489-9480
Mailing Address - Street 1:538 LIPPINCOTT DR BLDG E
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4806
Mailing Address - Country:US
Mailing Address - Phone:856-489-0505
Mailing Address - Fax:856-616-9259
Practice Address - Street 1:538 LIPPINCOTT DR BLDG E
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4806
Practice Address - Country:US
Practice Address - Phone:856-489-0505
Practice Address - Fax:856-489-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07553000261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center