| Nj South Coast Medical Center Corp | |
|
37 Main St Ste 5 Clinton NJ 08809 | |
| (609) 582-0899 | |
| Not Available |
| Full Name | Nj South Coast Medical Center Corp |
|---|---|
| Speciality | Family Medicine |
| Location | 37 Main St Ste 5, Clinton, New Jersey |
| Authorized Official Name and Position | Ebere Ezeanya (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9737045644 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nj South Coast Medical Center Corp 4995 Derby Ln Bethlehem PA 18020-9418 Ph: (973) 704-5644 | Nj South Coast Medical Center Corp 37 Main St Ste 5 Clinton NJ 08809 Ph: (609) 582-0899 |
| NPI Number | 1952739690 |
|---|---|
| Provider Enumeration Date | 10/15/2013 |
| Last Update Date | 08/21/2019 |
| Medicare PECOS PAC ID | 2567690761 |
|---|---|
| Medicare Enrollment ID | O20140115001270 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952739690 | NPI | - | NPPES |
| 0357367 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 25MA09219400 (New Jersey) | Primary |
| Provider Name | Ebere N Ezeanya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053547919 PECOS PAC ID: 9830354232 Enrollment ID: I20140115001318 |
| Provider Name | Theresa Aryee Baffour |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609528223 PECOS PAC ID: 5991191231 Enrollment ID: I20220413001105 |
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