Provider Demographics
NPI:1770855496
Name:VISITING PHYSICIAN ASSOCIATES OF SOUTH JERSEY, LLC
Entity Type:Organization
Organization Name:VISITING PHYSICIAN ASSOCIATES OF SOUTH JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MA'SHEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-567-9003
Mailing Address - Street 1:640 NORTH WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-9602
Mailing Address - Country:US
Mailing Address - Phone:609-567-9003
Mailing Address - Fax:858-373-2480
Practice Address - Street 1:640 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-9602
Practice Address - Country:US
Practice Address - Phone:609-567-9003
Practice Address - Fax:858-373-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00352500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty