Provider Demographics
NPI:1073507166
Name:SOUTH JERSEY HEART GROUP
Entity Type:Organization
Organization Name:SOUTH JERSEY HEART GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:NELENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:856-589-0300
Mailing Address - Street 1:9 ARBOUR LN
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3710
Mailing Address - Country:US
Mailing Address - Phone:856-371-9928
Mailing Address - Fax:
Practice Address - Street 1:539 EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2371
Practice Address - Country:US
Practice Address - Phone:856-589-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00033300282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital