Provider Demographics
NPI:1588970685
Name:SOUTH JERSEY HEALTHCARE OCCUPATIONAL HEALTH SERVICES
Entity type:Organization
Organization Name:SOUTH JERSEY HEALTHCARE OCCUPATIONAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:CERVINI
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C
Authorized Official - Phone:856-507-8548
Mailing Address - Street 1:1038 E CHESTNUT AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5800
Mailing Address - Country:US
Mailing Address - Phone:856-507-8548
Mailing Address - Fax:856-507-2709
Practice Address - Street 1:1038 E CHESTNUT AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5800
Practice Address - Country:US
Practice Address - Phone:856-507-8548
Practice Address - Fax:856-507-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00272600261Q00000X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center