=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750444998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERNAL MEDICNE OF SOUTH JERSEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 S BROADWAY SUITE B
-----------------------------------------------------
City | PENNSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08070-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-678-9900
-----------------------------------------------------
Fax | 856-678-9901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 S BROADWAY SUITE B
-----------------------------------------------------
City | PENNSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08070-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-678-9900
-----------------------------------------------------
Fax | 856-678-9901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PHYSICIAN
-----------------------------------------------------
Name | NOMAN SAIF
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 856-678-9900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 25MA06485600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------