Provider Demographics
NPI:1851906671
Name:SOUTH JERSEY CENTER FOR INFLAMMATORY DISEASE'S
Entity Type:Organization
Organization Name:SOUTH JERSEY CENTER FOR INFLAMMATORY DISEASE'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-300-9055
Mailing Address - Street 1:600 MARLTON PIKE WEST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3598
Mailing Address - Country:US
Mailing Address - Phone:856-375-2092
Mailing Address - Fax:
Practice Address - Street 1:600 MARLTON PIKE WEST
Practice Address - Street 2:SUITE C
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3598
Practice Address - Country:US
Practice Address - Phone:856-375-2092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy