Provider Demographics
NPI:1578963435
Name:MEDICAL ALLIANCE OF SOUTHERN NEW JERSEY PC
Entity Type:Organization
Organization Name:MEDICAL ALLIANCE OF SOUTHERN NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUSTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:856-462-6250
Mailing Address - Street 1:1206 W SHERMAN AVE
Mailing Address - Street 2:BUILDING1
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6911
Mailing Address - Country:US
Mailing Address - Phone:856-462-6250
Mailing Address - Fax:856-462-6226
Practice Address - Street 1:1206 W SHERMAN AVE
Practice Address - Street 2:BUILDING1
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6911
Practice Address - Country:US
Practice Address - Phone:856-462-6250
Practice Address - Fax:856-462-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty