1588970685 NPI number — SOUTH JERSEY HEALTHCARE OCCUPATIONAL HEALTH SERVICES

Table of content: (NPI 1588970685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588970685 NPI number — SOUTH JERSEY HEALTHCARE OCCUPATIONAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH JERSEY HEALTHCARE OCCUPATIONAL HEALTH SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588970685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1038 E CHESTNUT AVE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08360-5800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-507-8548
Provider Business Mailing Address Fax Number:
856-507-2709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1038 E CHESTNUT AVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360-5800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-507-8548
Provider Business Practice Location Address Fax Number:
856-507-2709
Provider Enumeration Date:
08/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CERVINI
Authorized Official First Name:
KELLIE
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
856-507-8548

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  26NJ00272600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0100X , with the licence number: 26NJ00272600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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