Healthcare Provider Details

I. General information

NPI: 1598207102
Provider Name (Legal Business Name): SOUTH JERSEY UROGYNECOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 CHURCH RD SUITE 600
MARLTON NJ
08053-9402
US

IV. Provider business mailing address

127 CHURCH RD SUITE 600
MARLTON NJ
08053-9402
US

V. Phone/Fax

Practice location:
  • Phone: 856-607-2273
  • Fax:
Mailing address:
  • Phone: 856-607-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDY B NOSSEIR
Title or Position: OWNER/FOUNDER
Credential: M.D.
Phone: 856-607-2273