Individual
DR. ARNOLD GLEN FONTANILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6981 NORTH PARK DRIVE, COOOPER RIVER WEST OFFICE BUILDING, PENNSAUKEN, NJ 08109
(856) 663-4949
(856) 663-6076
Mailing address
301 LIPPINCOTT DR STE 410, MARLTON, NJ 08053-4197
(856) 355-0340
(856) 355-0330
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB07716400
NJ
207Q00000X
Family Medicine Physician
OS012536
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1014376180001
—
PA
Enumeration date
08/16/2006
Last updated
10/16/2020
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