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General NPI Number Information
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NPI Number | 1992035190
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY PAIN MANAGEMENT
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 76 WEST JIM LEEDS RD PARK CENTRE SUITE 501
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City | GALLOWAY
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State | NJ
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Zip | 08205-9411
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Country | US
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Telephone | 609-568-5567
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Fax | 609-568-5614
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Provider Business Mailing Address
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Address Line | 76 WEST JIM LEEDS RD - PARK CENTRE SUITE 501
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City | GALLOWAY
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State | NJ
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Zip | 08205-9411
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Country | US
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Telephone | 609-568-5567
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Fax | 609-568-5614
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SALVATORE JOSEPH CERNIGLIA
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Credential | DO
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Telephone | 609-568-5567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 25MD02391600
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License Number State | NJ
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