Dr. Lyle Marnin Back

 

NPI Number Detailed Information

Provider Information:

Name:	Dr. Lyle Marnin Back
Gender:	M
Provider License Number If Given:	MA046399

NPI Information:

NPI:	1639172679
Entity Type (Individual or Organization):	1-ind
Enumeration Date:	5/23/2005
Last Update Date:	7/8/2007

Provider Business Mailing Address:

Address:	1942 ROUTE 70 E Cherry Hill, NJ 08003
Phone Number:	8567517550
Fax Number:	8567517544

Provider Business Practice Location Address:

Address:	1942 ROUTE 70 E Cherry Hill, NJ 08003
Phone Number:	8567517550
Fax Number:	8567517544

Provider Taxonomy:

Primary:	208200000X
Secondary (if any):
State:	NJ