Provider Demographics
NPI:1801155338
Name:SNJ MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:SNJ MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-283-0273
Mailing Address - Street 1:17 TWILIGHT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19464
Mailing Address - Country:US
Mailing Address - Phone:610-454-9545
Mailing Address - Fax:610-454-9545
Practice Address - Street 1:17 TWILIGHT CIRCLE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19464
Practice Address - Country:US
Practice Address - Phone:610-454-9545
Practice Address - Fax:610-454-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050115L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty