Individual
SAMANTHA BORNHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1410 DELSEA DR, DEPTFORD, NJ 08096-4101
(856) 579-8897
Mailing address
1410 DELSEA DR, DEPTFORD, NJ 08096-4101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00728900
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2022
Last updated
11/04/2022
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