Organization
HYDRATION CLINICS OF AMERICA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMALIA FANTASIA PHD (ADMINSTOR)
(856) 489-0555
Entity
Organization
Contact information
Practice address
538 LIPPINCOTT DR, BLG E, MARLTON, NJ 08053-4806
(856) 489-0555
(856) 489-0505
Mailing address
538 LIPPINCOTT DR, BLG E, MARLTON, NJ 08053-4806
(856) 489-0555
(856) 489-0505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB05610900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12352000775
UPIN
NJ
Enumeration date
12/27/2016
Last updated
12/27/2016
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