1437311842 NPI number — PREMIER OBSTETRICS AND GYNECOLOGY OF SOUTH JERSEY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437311842 NPI number — PREMIER OBSTETRICS AND GYNECOLOGY OF SOUTH JERSEY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER OBSTETRICS AND GYNECOLOGY OF SOUTH JERSEY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437311842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 EVESHAM ROAD
Provider Second Line Business Mailing Address:
PAVILIONS SUITE # 504
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-4506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-772-2300
Provider Business Mailing Address Fax Number:
856-772-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 EVESHAM ROAD
Provider Second Line Business Practice Location Address:
PAVILIONS SUITE # 504
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-772-2300
Provider Business Practice Location Address Fax Number:
856-772-2301
Provider Enumeration Date:
06/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FELSENSTEIN
Authorized Official First Name:
ROBERTA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
856-625-2044

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  25MA074348 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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