Basic Information
| Provider Information | |||||||||
| NPI: | 1285680694 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INFECTIOUS DISEASE PHYSICIANS, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 BRIGGS RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080544100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568667466 | ||||||||
| FaxNumber: | 8568669088 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 BRIGGS RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080544100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568667466 | ||||||||
| FaxNumber: | 8568669088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ANTOLIK | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8568667466 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.