Healthcare Provider Details

I. General information

NPI: 1518320555
Provider Name (Legal Business Name): COMPLETE CARE OF SOUTH JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BYPASS RD STE 104
SALEM NJ
08079-2053
US

IV. Provider business mailing address

4 BYPASS RD STE 104
SALEM NJ
08079-2053
US

V. Phone/Fax

Practice location:
  • Phone: 856-887-3005
  • Fax: 856-759-4035
Mailing address:
  • Phone: 856-887-3005
  • Fax: 856-759-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ00328900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MA06336400
License Number StateNJ

VIII. Authorized Official

Name: DR. WAMIQ SULTAN
Title or Position: OWNER
Credential: MD
Phone: 856-887-3005