Organization
GARDEN STATE MEDICAL ASSOC P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE VITO LOMONACO D.O. (VICE PRESIDENT)
(856) 983-2848
Entity
Organization
Contact information
Practice address
100 BRICK RD, SUITE 209, MARLTON, NJ 08053-2146
(856) 983-2848
(856) 985-7645
Mailing address
100 BRICK RD, SUITE 209, MARLTON, NJ 08053-2146
(856) 983-2848
(856) 985-7645
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2623307
—
NJ
Enumeration date
07/08/2006
Last updated
07/21/2022
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