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General NPI Number Information
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NPI Number | 1346537917
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Entity Type | Organization
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Legal Business Name | SOUTH MAIN MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 1317 S MAIN RD SUITE 2 C
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City | VINELAND
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State | NJ
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Zip | 08360-6511
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Country | US
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Telephone | 856-213-6080
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Fax | 856-213-6092
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Provider Business Mailing Address
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Address Line | 1317 S MAIN RD SUITE 2 C
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City | VINELAND
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State | NJ
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Zip | 08360-6511
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Country | US
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Telephone | 856-213-6080
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Fax | 856-213-6092
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Authorized Official
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Title or Position | OWNER
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Name | DR. OLGA KACZAJ
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Credential | M.D.
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Telephone | 856-213-6080
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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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