Healthcare Provider Details

I. General information

NPI: 1699216853
Provider Name (Legal Business Name): SOUTH JERSEY HYPERBARIC MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W SHERMAN AVE
VINELAND NJ
08360-7059
US

IV. Provider business mailing address

307 S EVERGREEN AVE
WOODBURY NJ
08096-2739
US

V. Phone/Fax

Practice location:
  • Phone: 856-641-8000
  • Fax:
Mailing address:
  • Phone: 856-686-4316
  • Fax: 865-291-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT WAGNER
Title or Position: OWNER
Credential: MD
Phone: 856-686-4316