Healthcare Provider Details

I. General information

NPI: 1619126984
Provider Name (Legal Business Name): SOUTH JERSEY GASTROENTEROLOGY CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 W SHERMAN AVE BLDG 2 UNIT A
VINELAND NJ
08360-6915
US

IV. Provider business mailing address

PO BOX 183
BRIDGETON NJ
08302-0137
US

V. Phone/Fax

Practice location:
  • Phone: 856-692-9900
  • Fax: 856-692-9911
Mailing address:
  • Phone: 856-451-9395
  • Fax: 856-451-8615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RIYADH HAMMOD
Title or Position: PRESIDENT
Credential: MD
Phone: 856-451-9395