Organization
LOURDES PERINATOLOGY SERVICES
Active
Parent organization
LOURDES PERINATOLOGY SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
LOURDES PERINATOLOGY SERVICES
Authorized official
DR. PETER KONCHAK D.O. (LEAD PHYSICIAN)
(856) 757-3993
Entity
Organization
Contact information
Practice address
1505 W SHERMAN AVE, VINELAND, NJ 08360-6912
(856) 507-8500
Mailing address
500 GROVE ST, SUITE 100, HADDON HEIGHTS, NJ 08035-1736
(856) 796-9200
(856) 310-5603
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
25MB06099100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3197603
—
NJ
Enumeration date
09/29/2008
Last updated
09/29/2008
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