Provider Demographics
NPI:1265874713
Name:NEMOURS NEW JERSEY PHYSICIAN PRACTICE, P.C.
Entity type:Organization
Organization Name:NEMOURS NEW JERSEY PHYSICIAN PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL & BUSINESS SVC OFF
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:MCKENDREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-697-5648
Mailing Address - Street 1:10140 CENTURION PKWY N
Mailing Address - Street 2:C/O MANAGED CARE
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:904-697-5629
Mailing Address - Fax:904-697-5630
Practice Address - Street 1:325 MARLTON PIKE E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2408
Practice Address - Country:US
Practice Address - Phone:856-309-8508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty