| Organization Name: | SOUTH JERSEY PEDIATRIC ENDOCRINOLOGY, LLC |
| NPI Number: | 1932346269 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AUGUSTINE O CHIKEZIE (MEDICAL DIRECTOR) |
| Mailing Address: | 6712 Washington Ave Suite 203 Egg Harbor Twp |
| State: | NJ US |
| Postal Code: | 082341999 |
| Phone Number: | 6092040698 |
| Fax Number: | 6092723099 |
| NPI Enumeration Date: | 01/08/2009 |
| NPI Last Update Date: | 01/08/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0800X |
| License Number: | 25MA05978100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Endoscopy |
| Taxonomy Definition: | |