Provider Demographics
NPI:1871520163
Name:SOUTH JERSEY OBSTETRICS & GYNECOLOGY P.A.
Entity type:Organization
Organization Name:SOUTH JERSEY OBSTETRICS & GYNECOLOGY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-465-7557
Mailing Address - Street 1:108 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2224
Mailing Address - Country:US
Mailing Address - Phone:609-465-7557
Mailing Address - Fax:609-465-9383
Practice Address - Street 1:108 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2224
Practice Address - Country:US
Practice Address - Phone:609-465-7557
Practice Address - Fax:609-465-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA036585207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0880008000OtherAMERIHEALTH GROUP #
NJ0079462000OtherAMERIHEALTH PROVIDER #
NJ0079462000OtherAMERIHEALTH PROVIDER #
NJC53252Medicare UPIN