=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699712810
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELDON D SOLOMON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2006
-----------------------------------------------------
Last Update Date | 05/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 E. EVESHAM ROAD BLDG 800, SUITE 115
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-424-5005
-----------------------------------------------------
Fax | 856-424-4716
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 E. EVESHAM ROAD BLDG 800, SUITE 115
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-4509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-424-5005
-----------------------------------------------------
Fax | 856-424-4716
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 25MA02431500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------