Healthcare Provider Details

I. General information

NPI: 1154186294
Provider Name (Legal Business Name): SOUTH JERSEY GERIATRIC CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 KRESSON RD FL 2
CHERRY HILL NJ
08034-3228
US

IV. Provider business mailing address

61 KRESSON RD FL 2
CHERRY HILL NJ
08034-3228
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-3494
  • Fax: 856-229-7683
Mailing address:
  • Phone: 856-429-3494
  • Fax: 856-229-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LORI A HEBERLEY
Title or Position: PRESIDENT
Credential: LPC
Phone: 856-429-3494