Provider Demographics
NPI:1154186294
Name:SOUTH JERSEY GERIATRIC CARE, PC
Entity type:Organization
Organization Name:SOUTH JERSEY GERIATRIC CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEBERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:856-429-3494
Mailing Address - Street 1:61 KRESSON RD FL 2
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3228
Mailing Address - Country:US
Mailing Address - Phone:856-429-3494
Mailing Address - Fax:856-229-7683
Practice Address - Street 1:61 KRESSON RD FL 2
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3228
Practice Address - Country:US
Practice Address - Phone:856-429-3494
Practice Address - Fax:856-229-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health