Provider Demographics
NPI:1306846001
Name:SALEM CLINIC CORP
Entity Type:Organization
Organization Name:SALEM CLINIC CORP
Other - Org Name:SOUTH JERSEY FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-9600
Mailing Address - Street 1:499 BECKETT RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOGAN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1766
Mailing Address - Country:US
Mailing Address - Phone:856-241-2090
Mailing Address - Fax:856-241-2099
Practice Address - Street 1:499 BECKETT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOGAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1766
Practice Address - Country:US
Practice Address - Phone:856-241-2090
Practice Address - Fax:856-241-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7211601Medicaid
NJ7211601Medicaid