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General NPI Number Information
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NPI Number | 1871520163
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY OBSTETRICS & GYNECOLOGY P.A.
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 108 MECHANIC ST
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City | CAPE MAY COURT HOUSE
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State | NJ
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Zip | 08210-2224
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Country | US
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Telephone | 609-465-7557
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Fax | 609-465-9383
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Provider Business Mailing Address
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Address Line | 108 MECHANIC ST
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City | CAPE MAY COURT HOUSE
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State | NJ
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Zip | 08210-2224
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Country | US
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Telephone | 609-465-7557
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Fax | 609-465-9383
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE R. NOLL
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Credential | M.D.
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Telephone | 609-465-7557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MA036585
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License Number State | NJ
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