Healthcare Provider Details

I. General information

NPI: 1013136456
Provider Name (Legal Business Name): SOUTH JERSEY MUSCULOSKELETAL INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 EGG HARBOR RD STE B
SEWELL NJ
08080-2326
US

IV. Provider business mailing address

556 EGG HARBOR ROAD
SEWELL NJ
08080
US

V. Phone/Fax

Practice location:
  • Phone: 856-256-7620
  • Fax: 856-256-7621
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH MCCARTHY
Title or Position: INTERIM ADMINISTRATOR
Credential: RN
Phone: 856-256-7620