Basic Information
| Provider Information | |||||||||
| NPI: | 1235334814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOTE | ||||||||
| FirstName: | MARIAN | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 BROADACRE DR | ||||||||
| Address2: | |||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080544705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562341031 | ||||||||
| FaxNumber: | 8566656907 | ||||||||
| Practice Location | |||||||||
| Address1: | MERCHANTVILLE PEDIATRICS- A DIVISION OF CHA | ||||||||
| Address2: | 1 S. CENTRE STREET, SUITE 100 | ||||||||
| City: | MERCHANTVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566657337 | ||||||||
| FaxNumber: | 8566653938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 26NN05232700 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 26NN05232700 | 01 | NJ | NJ WITH PERSCRIPTIVE AUTH | OTHER | MM0567909 | 01 | NJ | DEA | OTHER |