Provider Demographics
NPI: | 1013136456 |
---|---|
Name: | SOUTH JERSEY MUSCULOSKELETAL INSTITUTE, LLC |
Entity Type: | Organization |
Organization Name: | SOUTH JERSEY MUSCULOSKELETAL INSTITUTE, LLC |
Other - Org Name: | ADVANCED SURGICAL INSTITUTE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | INTERIM ADMINISTRATOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | ELIZABETH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MCCARTHY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN |
Authorized Official - Phone: | 856-256-7620 |
Mailing Address - Street 1: | 556 EGG HARBOR ROAD |
Mailing Address - Street 2: | |
Mailing Address - City: | SEWELL |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08080 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 556 EGG HARBOR RD STE B |
Practice Address - Street 2: | |
Practice Address - City: | SEWELL |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08080-2326 |
Practice Address - Country: | US |
Practice Address - Phone: | 856-256-7620 |
Practice Address - Fax: | 856-256-7621 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-24 |
Last Update Date: | 2023-06-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |