Provider Demographics
NPI:1306871314
Name:SOUTH JERSEY HEALTH SYSTEM EMERGENCY PHYSICIAN SERVICES P A
Entity type:Organization
Organization Name:SOUTH JERSEY HEALTH SYSTEM EMERGENCY PHYSICIAN SERVICES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ER DEPT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DI CINDIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-969-1000
Mailing Address - Street 1:307 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2739
Mailing Address - Country:US
Mailing Address - Phone:856-686-4316
Mailing Address - Fax:865-291-3254
Practice Address - Street 1:501 FRONT ST
Practice Address - Street 2:
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-2101
Practice Address - Country:US
Practice Address - Phone:856-363-1000
Practice Address - Fax:856-358-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0706819000OtherAMERIHEALTH
NJ7580606Medicaid
NJ7580606Medicaid
NJ0706819000OtherAMERIHEALTH
NJ0706819000OtherAMERIHEALTH