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General NPI Number Information
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NPI Number | 1225264666
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Entity Type | Organization
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Legal Business Name | SOUTHERN OCEAN SPECIALITY PHYSICIANS
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Dates
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Enumeration Date | 05/29/2009
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 1100 ROUTE 72 W STE 305
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2475
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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 | 1100 ROUTE 72 W STE 305
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2475
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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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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | EDWARD NIEWIADOMSKI
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Credential |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | NJ
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