Healthcare Provider Details

I. General information

NPI: 1154732907
Provider Name (Legal Business Name): JERSEY SHORE SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W CONNECTICUT AVE
SOMERS POINT NJ
08244-1975
US

IV. Provider business mailing address

10 W CONNECTICUT AVE
SOMERS POINT NJ
08244-1975
US

V. Phone/Fax

Practice location:
  • Phone: 609-904-2565
  • Fax: 609-904-2566
Mailing address:
  • Phone: 609-904-2565
  • Fax: 609-904-2566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25MB08601300
License Number StateNJ

VIII. Authorized Official

Name: BRIAN SOKALSKY
Title or Position: OWNER
Credential: DO
Phone: 609-904-2565