Provider Demographics
NPI:1336323104
Name:SURGICAL SERVICES OF SOUTH JERSEY, LLC
Entity Type:Organization
Organization Name:SURGICAL SERVICES OF SOUTH JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNFA
Authorized Official - Phone:609-922-0909
Mailing Address - Street 1:13 ELM DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8840
Mailing Address - Country:US
Mailing Address - Phone:973-957-2548
Mailing Address - Fax:866-395-0888
Practice Address - Street 1:13 ELM DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8840
Practice Address - Country:US
Practice Address - Phone:973-957-0548
Practice Address - Fax:866-395-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO05331500314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility