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General NPI Number Information
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NPI Number | 1205161197
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Entity Type | Individual
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Provider Name | REBAKAH SUMALINI ABEL BOENERJOUS MD
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Gender | Female
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 95 WOODSTOWN RD SUITE B
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City | SWEDESBORO
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State | NJ
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Zip | 08085-3181
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Country | US
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Telephone | 856-832-4359
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Fax | 856-832-4381
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Provider Business Mailing Address
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Address Line | 310 WOODSTOWN RD
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City | SALEM
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State | NJ
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Zip | 08079
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Country | US
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Telephone | 856-835-4359
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | C1-0009183
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA09544500
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License Number State | NJ
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