| Organization Name: | PHOENIX ASSOCIATES LLC |
| NPI Number: | 1619255288 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SCOTT ALAN HERNBERG (MEDICAL DIRECTOR) |
| Mailing Address: | 1601 Tilton Rd Suite 4 Northfield |
| State: | NJ US |
| Postal Code: | 082251877 |
| Phone Number: | 6094071119 |
| Fax Number: | |
| NPI Enumeration Date: | 07/29/2011 |
| NPI Last Update Date: | 07/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 25MB04215800 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |