Provider Demographics
NPI:1164503363
Name:SOUTH JERSEY CHEST DISEASES,PA
Entity Type:Organization
Organization Name:SOUTH JERSEY CHEST DISEASES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-561-7666
Mailing Address - Street 1:107 VINE ST
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037
Mailing Address - Country:US
Mailing Address - Phone:609-561-7666
Mailing Address - Fax:609-567-8347
Practice Address - Street 1:107 VINE ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1447
Practice Address - Country:US
Practice Address - Phone:609-561-7666
Practice Address - Fax:609-567-8347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB39383207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4618009Medicaid
NJ687066OtherAMERIHEALTH
NJ56729OtherAETNA
NJ56729OtherAETNA