Individual
VAN DAUTRUCHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
57 COOPER ST, WOODBURY, NJ 08096-4650
(856) 384-9433
Mailing address
57 COOPER ST, WOODBURY, NJ 08096-4650
(856) 384-9433
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/09/2015
Last updated
07/09/2015
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