Individual
GREGORY BLASE PERSICHETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
100 KINGS WAY E, SUITE A-3, SEWELL, NJ 08080-2237
(856) 589-3331
(856) 589-3416
Mailing address
100 KINGS WAY E, SUITE A-3, SEWELL, NJ 08080-2237
(856) 589-3331
(856) 589-3416
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
08012552
PA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
25MB08242000
NJ
Other
Enumeration date
06/15/2006
Last updated
12/03/2015
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