Provider Demographics
NPI:1982800587
Name:SICKLERVILLE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:SICKLERVILLE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-227-6575
Mailing Address - Street 1:1305 KINGS HWY N
Mailing Address - Street 2:STE.1
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1919
Mailing Address - Country:US
Mailing Address - Phone:856-429-7600
Mailing Address - Fax:856-429-7130
Practice Address - Street 1:1305 KINGS HWY N
Practice Address - Street 2:STE.1
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1919
Practice Address - Country:US
Practice Address - Phone:856-429-7600
Practice Address - Fax:856-429-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05722900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty