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General NPI Number Information
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NPI Number | 1578563052
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Entity Type | Organization
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Legal Business Name | SALEM CLINIC CORP
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Dates
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Enumeration Date | 07/27/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4 BYPASS ROAD SUITE 101
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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 | 856-935-3582
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Fax | 856-935-4382
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Provider Business Mailing Address
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Address Line | 4 BYPASS ROAD SUITE 101
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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 | 856-935-3582
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Fax | 856-935-4382
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY D NEWSOME
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Credential |
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Telephone | 616-373-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | NJ
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