Provider Demographics
NPI:1558431296
Name:SOUTH JERSEY CENTER FOR ORTHOPEDICS & SPORTS MEDICINE
Entity Type:Organization
Organization Name:SOUTH JERSEY CENTER FOR ORTHOPEDICS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:BERNARDINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-696-0900
Mailing Address - Street 1:994 W SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6937
Mailing Address - Country:US
Mailing Address - Phone:856-696-0900
Mailing Address - Fax:856-692-4769
Practice Address - Street 1:994 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6937
Practice Address - Country:US
Practice Address - Phone:856-696-0900
Practice Address - Fax:856-692-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA35858207X00000X
NJ25MA03585800332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6385580001Medicare NSC
NJ003468Medicare Oscar/Certification