Provider Demographics
NPI:1295530665
Name:FOUNTAIN, RAYMOND J JR
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:FOUNTAIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 FRIES MILL RD
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2059
Mailing Address - Country:US
Mailing Address - Phone:856-302-1506
Mailing Address - Fax:
Practice Address - Street 1:245 FRIES MILL RD
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2059
Practice Address - Country:US
Practice Address - Phone:856-302-1506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00161500237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist