Provider Demographics
NPI:1396090510
Name:EMRICH, JEFFREY STEVEN (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STEVEN
Last Name:EMRICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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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:856-355-0330
Practice Address - Street 1:401 YOUNG AVE STE 275
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3141
Practice Address - Country:US
Practice Address - Phone:856-291-8670
Practice Address - Fax:856-291-8671
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2024-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOT014499208600000X
NJ25MB10627400208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0693464Medicaid