Organization
THE ESTAUGH T/A MEDFORD LEAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMY M VICKERS (CHIEF EXECUTIVE OFFICER)
(609) 654-3009
Entity
Organization
Contact information
Practice address
1 MEDFORD LEAS, MEDFORD, NJ 08055-2254
(609) 654-3005
(609) 654-7894
Mailing address
1 MEDFORD LEAS, MEDFORD, NJ 08055-2254
(609) 654-3005
(609) 654-7894
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
06/29/2006
Last updated
07/15/2022
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