1518320555 NPI number — COMPLETE CARE OF SOUTH JERSEY

Table of content: (NPI 1518320555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518320555 NPI number — COMPLETE CARE OF SOUTH JERSEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE CARE OF SOUTH JERSEY
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:
1518320555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3241 SARUM FARM LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNET VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19060-2258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-339-6038
Provider Business Mailing Address Fax Number:
856-494-1549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 ROUTE 45
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08079-2064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-339-6038
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SULTAN
Authorized Official First Name:
WAMIQ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
856-912-0412

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  25MA06336400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP2300X , with the licence number: 26NJ00328900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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