=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760367890
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH JERSEY FERTILITY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2025
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 LIPPINCOTT DR STE 130
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-4161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-596-2233
-----------------------------------------------------
Fax | 856-596-2411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 227 LAUREL RD STE 300
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-8303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-669-6050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF REVENUE CYCLE MGMT
-----------------------------------------------------
Name | MICHELLE E JARED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 763-294-2012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------