Healthcare Provider Details

I. General information

NPI: 1972907772
Provider Name (Legal Business Name): ALLIED PHYSICIANS OF SJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 W SHERMAN AVE BUILDING 1 SUITE A
VINELAND NJ
08360-6911
US

IV. Provider business mailing address

1206 W SHERMAN AVE BUILDING 1 SUITE A
VINELAND NJ
08360-6911
US

V. Phone/Fax

Practice location:
  • Phone: 856-692-7700
  • Fax: 856-213-5403
Mailing address:
  • Phone: 856-692-7700
  • Fax: 856-213-5403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06786000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA044099000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MB04980000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MB07794500
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHAEL DOVNARSKY
Title or Position: DOCTOR
Credential: M.D.
Phone: 856-692-7700