Provider Demographics
NPI:1386895209
Name:DEAN M GODFREY, D.O., LLC
Entity type:Organization
Organization Name:DEAN M GODFREY, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-510-4761
Mailing Address - Street 1:1603 W MCGALLIARD AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-3209
Mailing Address - Country:US
Mailing Address - Phone:609-510-4761
Mailing Address - Fax:
Practice Address - Street 1:425 12TH ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1382
Practice Address - Country:US
Practice Address - Phone:609-567-9168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty