Peach Assistance Program

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

PEACH ASSISTANCE PROGRAM

Practice address

1172 Tristram Cir
Mantua, NJ 08051-2205

Phone

(856) 822-0453

Fax

(856) 539-5820

NPI assigned

Mar 4, 2021

Last updated

Mar 4, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Allison G Allen Fundenberg, MEDICAL CONSULTANT

Title

President

Phone

(856) 822-0453

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1477148252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1172 TRISTRAM CIR",
            "city": "MANTUA",
            "state": "NJ",
            "postal_code": "080512205",
            "telephone_number": "856-822-0453",
            "fax_number": "856-539-5820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1172 TRISTRAM CIR",
            "city": "MANTUA",
            "state": "NJ",
            "postal_code": "080512205",
            "telephone_number": "856-822-0453",
            "fax_number": "856-539-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH ASSISTANCE PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A",
        "authorized_official_last_name": "ALLEN FUNDENBERG",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-822-0453",
        "authorized_official_credential": "MEDICAL  CONSULTANT"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Voluntary or Charitable Agency in Mantua, NJ
• Providers in Mantua, NJ by specialty
• Voluntary or Charitable Agency in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.