Provider Demographics
NPI:1902442064
Name:SOUTH JERSEY WELLNESS GROUP
Entity Type:Organization
Organization Name:SOUTH JERSEY WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRENI BERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-764-9685
Mailing Address - Street 1:1919 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1115
Mailing Address - Country:US
Mailing Address - Phone:856-761-8100
Mailing Address - Fax:
Practice Address - Street 1:1919 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1115
Practice Address - Country:US
Practice Address - Phone:856-761-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty