Healthcare Provider Details

I. General information

NPI: 1871520163
Provider Name (Legal Business Name): SOUTH JERSEY OBSTETRICS & GYNECOLOGY P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MECHANIC ST
CAPE MAY COURT HOUSE NJ
08210-2224
US

IV. Provider business mailing address

108 MECHANIC ST
CAPE MAY COURT HOUSE NJ
08210-2224
US

V. Phone/Fax

Practice location:
  • Phone: 609-465-7557
  • Fax: 609-465-9383
Mailing address:
  • Phone: 609-465-7557
  • Fax: 609-465-9383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA036585
License Number StateNJ

VIII. Authorized Official

Name: DR. BRUCE R. NOLL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 609-465-7557