Healthcare Provider Details

I. General information

NPI: 1699978908
Provider Name (Legal Business Name): SOUTH JERSEY WOMEN'S CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 HADDONFIELD RD
CHERRY HILL NJ
08002-2747
US

IV. Provider business mailing address

1014 HADDONFIELD RD
CHERRY HILL NJ
08002-2747
US

V. Phone/Fax

Practice location:
  • Phone: 856-662-5282
  • Fax: 856-662-5485
Mailing address:
  • Phone: 856-662-5282
  • Fax: 856-662-5485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number25MB03433900
License Number StateNJ

VIII. Authorized Official

Name: DR. GEORGE BERNARD DAINOFF
Title or Position: PHYSICIAN
Credential: DO
Phone: 856-662-5282