NPI Code Detail JSON Logo

1457092611 NPI number — PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOC OF SOUTHERN NJ LLC

NPI Number: 1457092611
Health Care Provider/Practitioner: PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOC OF SOUTHERN NJ LLC

Information about “1457092611” NPI (PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOC OF SOUTHERN NJ LLC) exists in 1457092611 in HTML format HTML  |  1457092611 in plain Text format TXT  |  1457092611 in PDF (Portable Document Format) PDF  |  1457092611 in an XML format XML  formats.

NPI Number : 1457092611 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457092611",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOC OF SOUTHERN NJ LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "352 S DELSEA DR UNIT C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VINELAND",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08360-5308",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "856-690-1616",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4 BURTON LN STE 300",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MULLICA HILL",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08062-9441",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "856-690-1616",
    "PracticeLocationAddressFaxNumber": "856-690-1089",
    "EnumerationDate": "04/04/2022",
    "LastUpdateDate": "09/27/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SHEPHERD",
    "AuthorizedOfficialFirstName": "VERNA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "ADMINISTRATOR OF PHYSICIAN SERVICES",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "856-690-1616",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207X00000X",
        "TaxonomyName": "Orthopaedic Surgery Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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