Provider Demographics
NPI:1598803793
Name:ENDOCRINE ASSOCIATES OF SOUTH JERSEY P C
Entity Type:Organization
Organization Name:ENDOCRINE ASSOCIATES OF SOUTH JERSEY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:EMILY
Authorized Official - Last Name:POPILOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-727-0900
Mailing Address - Street 1:703 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057
Mailing Address - Country:US
Mailing Address - Phone:856-727-0900
Mailing Address - Fax:856-231-8428
Practice Address - Street 1:703 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:856-727-0900
Practice Address - Fax:856-231-8428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3450805Medicaid
NJCN7115OtherRAILROAD MEDICARE
NJ631927Medicare PIN