Provider Demographics
NPI:1992035190
Name:SOUTH JERSEY PAIN MANAGEMENT
Entity Type:Organization
Organization Name:SOUTH JERSEY PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CERNIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-568-5567
Mailing Address - Street 1:76 WEST JIM LEEDS RD - PARK CENTRE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9411
Mailing Address - Country:US
Mailing Address - Phone:609-568-5567
Mailing Address - Fax:609-568-5614
Practice Address - Street 1:76 WEST JIM LEEDS RD PARK CENTRE
Practice Address - Street 2:SUITE 501
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9411
Practice Address - Country:US
Practice Address - Phone:609-568-5567
Practice Address - Fax:609-568-5614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD02391600207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1725301Medicaid
052078Medicare PIN
NJ1725301Medicaid