Healthcare Provider Details

I. General information

NPI: 1174877757
Provider Name (Legal Business Name): S.O.B HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E JIMMIE LEEDS RD SUITE A
GALLOWAY NJ
08205-4127
US

IV. Provider business mailing address

335 E JIMMIE LEEDS RD SUITE A
GALLOWAY NJ
08205-4127
US

V. Phone/Fax

Practice location:
  • Phone: 609-573-5310
  • Fax: 609-241-1922
Mailing address:
  • Phone: 609-573-5310
  • Fax: 609-241-1922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number38MC00702600
License Number StateNJ

VIII. Authorized Official

Name: DR. EBENEZER O-A BILEWU
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: D.C
Phone: 609-573-5310