Healthcare Provider Details

I. General information

NPI: 1881694032
Provider Name (Legal Business Name): SALEM CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 BYPASS ROAD
SALEM NJ
08079
US

IV. Provider business mailing address

8 BYPASS ROAD
SALEM NJ
08079
US

V. Phone/Fax

Practice location:
  • Phone: 856-935-2750
  • Fax: 856-935-0105
Mailing address:
  • Phone: 856-935-2750
  • Fax: 856-935-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. GARY D NEWSOME
Title or Position: PRESIDENT
Credential:
Phone: 615-373-9600