Provider Demographics
NPI:1750444998
Name:INTERNAL MEDICNE OF SOUTH JERSEY
Entity Type:Organization
Organization Name:INTERNAL MEDICNE OF SOUTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-678-9900
Mailing Address - Street 1:250 S BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-2700
Mailing Address - Country:US
Mailing Address - Phone:856-678-9900
Mailing Address - Fax:856-678-9901
Practice Address - Street 1:250 S BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-2700
Practice Address - Country:US
Practice Address - Phone:856-678-9900
Practice Address - Fax:856-678-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06485600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7721803Medicaid
NJ099447Medicare ID - Type Unspecified
NJ7721803Medicaid