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General NPI Number Information
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NPI Number | 1588686604
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY SPORTS & SPINE MEDICINE LLC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 525 ROUTE 73 SOUTH EVESHAM COMMONS- SUITE 104A
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City | MARLTON
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State | NJ
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Zip | 08053-9643
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Country | US
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Telephone | 856-874-9777
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Fax | 856-874-9444
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Provider Business Mailing Address
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Address Line | PO BOX 22462
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City | PHILADELPHIA
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State | PA
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Zip | 19110-2462
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Country | US
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Telephone | 215-732-7600
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Fax | 856-874-9444
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Authorized Official
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Title or Position | OWNER
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Name | MERYL Y STEIN
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Credential | MD
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Telephone | 856-874-9777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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