Provider Demographics
NPI:1669525960
Name:SOUTH JERSEY MEDICAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:SOUTH JERSEY MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:INTELISANO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-228-0144
Mailing Address - Street 1:1504 BLACKWOOD CLEMENTON RD
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-4625
Mailing Address - Country:US
Mailing Address - Phone:856-228-0144
Mailing Address - Fax:856-232-0320
Practice Address - Street 1:1504 BLACKWOOD CLEMENTON RD
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-4625
Practice Address - Country:US
Practice Address - Phone:856-228-0144
Practice Address - Fax:856-232-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB05610900207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty