Organization
MIRMANESH MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN MIRMANESH MD (MEDICAL DIRECTOR)
(609) 980-5672
Entity
Organization
Contact information
Practice address
100 ROUTE 73, VOORHEES, NJ 08043-9575
(609) 753-7374
Mailing address
100 ROUTE 73, VOORHEES, NJ 08043-9575
(856) 753-7374
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
12/11/2017
Last updated
03/17/2018
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