Provider Demographics
NPI:1598207102
Name:SOUTH JERSEY UROGYNECOLOGY, LLC
Entity Type:Organization
Organization Name:SOUTH JERSEY UROGYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:NOSSEIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-607-2273
Mailing Address - Street 1:127 CHURCH RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9402
Mailing Address - Country:US
Mailing Address - Phone:856-607-2273
Mailing Address - Fax:
Practice Address - Street 1:127 CHURCH RD
Practice Address - Street 2:SUITE 600
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9402
Practice Address - Country:US
Practice Address - Phone:856-607-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty