Individual
SUNNY PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3 COOPER PLZ, SUTIE 411, CAMDEN, NJ 08103-1438
(856) 342-3275
(856) 968-8468
Mailing address
3 COOPER PLZ, SUITE 502, CAMDEN, NJ 08103-1438
(856) 963-6888
(856) 968-8499
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
MT183607
PA
208600000X
Surgery Physician
Primary
MA08846900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA08846900
STQATE LICENSE
NJ
Enumeration date
04/19/2007
Last updated
12/04/2010
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