Provider Demographics
NPI:1891135307
Name:SOUTH JERSEY MEDICAL CARE
Entity type:Organization
Organization Name:SOUTH JERSEY MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCIULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-839-3816
Mailing Address - Street 1:505 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08270-2577
Mailing Address - Country:US
Mailing Address - Phone:609-839-3816
Mailing Address - Fax:
Practice Address - Street 1:505 BEACH DR
Practice Address - Street 2:
Practice Address - City:CORBIN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08270-2577
Practice Address - Country:US
Practice Address - Phone:609-839-3816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition