Provider Demographics
NPI:1083943872
Name:SOUTH JERSEY FAMILY & SPECIALTY MEDICINE LLC
Entity type:Organization
Organization Name:SOUTH JERSEY FAMILY & SPECIALTY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-764-4115
Mailing Address - Street 1:2906 ROUTE 130 N
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-2521
Mailing Address - Country:US
Mailing Address - Phone:856-764-4115
Mailing Address - Fax:856-764-4116
Practice Address - Street 1:2906 ROUTE 130
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-2521
Practice Address - Country:US
Practice Address - Phone:856-764-4115
Practice Address - Fax:856-764-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2015-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07370900207Q00000X
NJ25MA08374000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty