Healthcare Provider Details

I. General information

NPI: 1609158732
Provider Name (Legal Business Name): SOUTH JERSEY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 TOMLIN STATION ROAD SUITE D
MULLICA HILL NJ
08062
US

IV. Provider business mailing address

333 IRVING AVE
BRIDGETON NJ
08302-2123
US

V. Phone/Fax

Practice location:
  • Phone: 856-423-8633
  • Fax:
Mailing address:
  • Phone: 856-575-4777
  • Fax: 856-575-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberNOT APPLICABLE
License Number State

VIII. Authorized Official

Name: MR. JOHN ALBERT DIANGELO
Title or Position: SR. VICE PRESIDENT FINANCE & CFO
Credential:
Phone: 856-641-8610