Organization
TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Active
Other names
NJ Sports Medicine Temple
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACEY J CLARK (DIRECTOR, GOVERNMENT AND PAYER RELA)
(856) 596-0906
Entity
Organization
Contact information
Practice address
ROUTE 73 N, ONE GREENTREE CENTER, MARLTON, NJ 08053
(856) 596-0906
(856) 596-6918
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(856) 596-0609
(856) 596-6918
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6202403
—
NJ
Enumeration date
10/07/2005
Last updated
02/13/2017
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