Provider Demographics
NPI:1740432202
Name:SOUTH JERSEY OSTEOPATHIC CARE CENTER, LLC
Entity Type:Organization
Organization Name:SOUTH JERSEY OSTEOPATHIC CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:CUMMINGS
Authorized Official - Last Name:REEH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-235-6800
Mailing Address - Street 1:701 E MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3032
Mailing Address - Country:US
Mailing Address - Phone:856-235-6800
Mailing Address - Fax:856-235-6811
Practice Address - Street 1:701 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3032
Practice Address - Country:US
Practice Address - Phone:856-235-6800
Practice Address - Fax:856-235-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB069721261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care