Individual
DR. SCOTT ALAN MODENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
128 ROUTE 70 STE 1B RIGHT, MEDFORD, NJ 08055-2371
(856) 237-8045
(856) 237-8047
Mailing address
301 LIPPINCOTT DR STE 410, MARLTON, NJ 08053-4197
(856) 355-0340
(856) 355-0330
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
25MA07874900
NJ
207RG0100X
Gastroenterology Physician
MD417817
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445894
—
NJ
01
—
1659328698
GROUP NPI #
NJ
01
—
1659328698
GROUP NPI #
PA
Enumeration date
05/03/2006
Last updated
10/08/2024
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