Provider Demographics
NPI:1124124706
Name:JAMIL, ERUM (MD)
Entity type:Individual
Prefix:
First Name:ERUM
Middle Name:
Last Name:JAMIL
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 1:10 E MAIN ST
Mailing Address - Street 2:STE A HOLLY CITY PEDIATRICS PA RIVERVIEW COMMERECE CENT
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332
Mailing Address - Country:US
Mailing Address - Phone:859-825-5932
Mailing Address - Fax:856-825-4819
Practice Address - Street 1:10 E MAIN ST
Practice Address - Street 2:STE A HOLLY CITY PEDIATRICS PA RIVERVIEW COMMERECE CENT
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332
Practice Address - Country:US
Practice Address - Phone:859-825-5932
Practice Address - Fax:856-825-4819
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07266900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8661901Medicaid