Individual
MR. NATHAN DOUGLAS COUNSELLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
201 HADDON AVE, HADDON TOWNSHIP, NJ 08108-2860
(856) 854-0300
Mailing address
408 SHEPPARD AVE, RUNNEMEDE, NJ 08078-1523
(856) 371-7214
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00497400
NJ
Other
Enumeration date
10/11/2018
Last updated
10/11/2018
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