MEDICARE: SOUTH JERSEY MEDICINE AND GERIATRICS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MA07533000	NJ

General Provider Information

NPI Number	:	1609829548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH JERSEY MEDICINE AND GERIATRICS, PC

Provider Business Mailing Address
First Line	:	103 CREEK CROSSING BLVD
Second Line	:
City	:	HAINESPORT
State	:	NJ
Zip	:	08036-2765
Country	:	US
Telephone Number	:	609-518-0999
Fax Number	:	609-518-0922

Provider Business Practice Location Address
First Line	:	103 CREEK CROSSING BLVD
Second Line	:
City	:	HAINESPORT
State	:	NJ
Zip	:	08036-2765
Country	:	US
Telephone Number	:	609-518-0999
Fax Number	:	609-518-0922

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. SAMEER RAMESH PATEL
Credential	:	MD
Telephone Number	:	609-518-0999

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	01/15/2008

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