Provider Demographics
NPI:1164800017
Name:SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC,
Entity Type:Organization
Organization Name:SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMINATA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-567-0434
Mailing Address - Street 1:1 N WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1875
Mailing Address - Country:US
Mailing Address - Phone:609-567-0434
Mailing Address - Fax:609-567-6428
Practice Address - Street 1:1125 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-4806
Practice Address - Country:US
Practice Address - Phone:609-348-0066
Practice Address - Fax:609-348-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty