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General NPI Number Information
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NPI Number | 1588970685
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY HEALTHCARE OCCUPATIONAL HEALTH SERVICES
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 1038 E CHESTNUT AVE SUITE 120
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City | VINELAND
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State | NJ
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Zip | 08360-5800
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Country | US
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Telephone | 856-507-8548
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Fax | 856-507-2709
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Provider Business Mailing Address
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Address Line | 1038 E CHESTNUT AVE SUITE 120
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City | VINELAND
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State | NJ
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Zip | 08360-5800
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Country | US
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Telephone | 856-507-8548
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Fax | 856-507-2709
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. KELLIE MAE CERVINI
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Credential | APN-C
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Telephone | 856-507-8548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 26NJ00272600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 26NJ00272600
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License Number State | NJ
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