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General NPI Number Information
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NPI Number | 1023041480
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Entity Type | Organization
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Legal Business Name | SOUTHERN OCEAN SPECIALTY PHYSICIANS, P.C.
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 1100 ROUTE 72 W SUITE 305
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2468
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Country | US
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Telephone | 609-978-3359
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Fax | 609-978-3060
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Provider Business Mailing Address
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Address Line | 1364 ROUTE 72 W
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2485
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Country | US
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Telephone | 609-971-7986
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Fax | 609-597-4557
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDWARD J NIEWIADOMSKI
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Credential | M.D.
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Telephone | 609-978-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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