Healthcare Provider Details

I. General information

NPI: 1194762534
Provider Name (Legal Business Name): SOUTH JERSEY ENT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 S DELSEA DR SUITE D
VINELAND NJ
08360-7079
US

IV. Provider business mailing address

2835 S DELSEA DR SUITE D
VINELAND NJ
08360-7079
US

V. Phone/Fax

Practice location:
  • Phone: 856-205-0800
  • Fax: 856-205-0024
Mailing address:
  • Phone: 856-205-0800
  • Fax: 856-205-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. EMIL P. LIEBMAN
Title or Position: M.D.
Credential: M.D.
Phone: 856-205-0800