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Organization

INTEGRATIVE MEDICINE AND BIOFEEDBACK CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
C. SAMUEL VERGHESE MD(AM), PHD (CLINICAL DIRECTOR)
(856) 222-9965
Entity
Organization

Contact information

Practice address
813 E GATE DR STE B, MOUNT LAUREL, NJ 08054-1238
(856) 222-9965
(856) 222-9916
Mailing address
813 E GATE DR STE B, MOUNT LAUREL, NJ 08054-1238
(856) 222-9965
(856) 222-9916

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
NJ
133NN1002X
Nutrition Education Nutritionist
175F00000X
Naturopath
175L00000X
Homeopath
207Q00000X
Family Medicine Physician
Primary
25MB05189200
NJ
246ZE0500X
EEG Specialist/Technologist
246ZE0600X
Electroneurodiagnostic Specialist/Technologist

Other

Enumeration date
01/08/2007
Last updated
09/11/2008
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