Provider Demographics
NPI:1205161197
Name:ABEL BOENERJOUS, REBAKAH SUMALINI (MD)
Entity type:Individual
Prefix:
First Name:REBAKAH SUMALINI
Middle Name:
Last Name:ABEL BOENERJOUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WOODSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079
Mailing Address - Country:US
Mailing Address - Phone:856-835-4359
Mailing Address - Fax:
Practice Address - Street 1:95 WOODSTOWN RD
Practice Address - Street 2:SUITE B
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-3181
Practice Address - Country:US
Practice Address - Phone:856-832-4359
Practice Address - Fax:856-832-4381
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0009183207R00000X
NJ25MA09544500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC10009183OtherDELAWARE LICENSE