Provider Demographics
NPI:1609158732
Name:SOUTH JERSEY HOSPITAL, INC.
Entity Type:Organization
Organization Name:SOUTH JERSEY HOSPITAL, INC.
Other - Org Name:SJH SPORTS REHAB CARE - TOMLIN STATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT FINANCE & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:DIANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-641-8610
Mailing Address - Street 1:333 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-2123
Mailing Address - Country:US
Mailing Address - Phone:856-575-4777
Mailing Address - Fax:856-575-4951
Practice Address - Street 1:201 TOMLIN STATION ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062
Practice Address - Country:US
Practice Address - Phone:856-423-8633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH JERSEY HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NOT APPLICABLE261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy