Provider Demographics
NPI:1922299288
Name:SETO MEDICAL PROVIDERS,LLC
Entity Type:Organization
Organization Name:SETO MEDICAL PROVIDERS,LLC
Other - Org Name:SETO MEDICAL PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-292-8216
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-0065
Mailing Address - Country:US
Mailing Address - Phone:856-292-8216
Mailing Address - Fax:856-848-3011
Practice Address - Street 1:100 W RED BANK AVE
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3407
Practice Address - Country:US
Practice Address - Phone:856-292-8216
Practice Address - Fax:856-848-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ122643Medicare PIN
NJDO4895Medicare PIN