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Organization
INTEGRATIVE MEDICINE AND BIOFEEDBACK CLINIC
Active
Organization
INTEGRATIVE MEDICINE AND BIOFEEDBACK CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
C. SAMUEL VERGHESE MD(AM), PHD (CLINICAL DIRECTOR)
(856) 222-9965
Entity
Organization
Contact information
Practice address
813 E GATE DR STE B, MOUNT LAUREL, NJ 08054-1238
(856) 222-9965
(856) 222-9916
Mailing address
813 E GATE DR STE B, MOUNT LAUREL, NJ 08054-1238
(856) 222-9965
(856) 222-9916
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
NJ
133NN1002X
Nutrition Education Nutritionist
—
—
175F00000X
Naturopath
—
—
175L00000X
Homeopath
—
—
207Q00000X
Family Medicine Physician
Primary
25MB05189200
NJ
246ZE0500X
EEG Specialist/Technologist
—
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
—
—
Other
Enumeration date
01/08/2007
Last updated
09/11/2008
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