Provider Demographics
NPI:1750929907
Name:TRUE NORTH MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:TRUE NORTH MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:PELTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-470-4776
Mailing Address - Street 1:PO BOX 1673
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-7673
Mailing Address - Country:US
Mailing Address - Phone:856-470-4776
Mailing Address - Fax:856-624-3572
Practice Address - Street 1:2510 MARYLAND RD STE 160
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1137
Practice Address - Country:US
Practice Address - Phone:215-672-6622
Practice Address - Fax:215-672-6566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUE NORTH MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-18
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty