Healthcare Provider Details

I. General information

NPI: 1285742197
Provider Name (Legal Business Name): SALEM MEDICAL PROFESSIONALS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 BECKETT RD
LOGAN TOWNSHIP NJ
08085-1766
US

IV. Provider business mailing address

PO BOX 504290
SAINT LOUIS MO
63150-0001
US

V. Phone/Fax

Practice location:
  • Phone: 856-241-2090
  • Fax: 856-241-2099
Mailing address:
  • Phone: 856-241-2090
  • Fax: 856-241-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: GARY D NEWSOME
Title or Position: PRESIDENT
Credential:
Phone: 616-373-9600