Provider Demographics
NPI:1215588447
Name:SOUTH JERSEY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH JERSEY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C
Authorized Official - Phone:609-451-1125
Mailing Address - Street 1:1304 ROUTE ROUTE 47 SOUTH
Mailing Address - Street 2:UNIT WU-N - 2ND FLOOR
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242
Mailing Address - Country:US
Mailing Address - Phone:609-451-1125
Mailing Address - Fax:
Practice Address - Street 1:1304 ROUTE ROUTE 47 SOUTH
Practice Address - Street 2:UNIT WU-N - 2ND FLOOR
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1416
Practice Address - Country:US
Practice Address - Phone:609-451-1125
Practice Address - Fax:609-438-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-29
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0561053Medicaid
NJ0697320Medicaid