# SOUTH JERSEY SPORTS MEDICINE CENTER PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316997331
- **Authorized official:** DIANE VERSAGGI (ADMINISTRATOR)
- **Authorized official phone:** (856) 589-0650

## Contact information

- **Practice address:** 556 EGG HARBOR RD, SUITE A, SEWELL, NJ 08080-2326
- **Practice address phone:** (856) 589-0650
- **Practice address fax:** (856) 589-2720
- **Mailing address:** 556 EGG HARBOR RD, SUITE A, SEWELL, NJ 08080-2326
- **Mailing address phone:** (856) 589-0650
- **Mailing address fax:** (856) 589-2720

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/11/2006
- **Last updated:** 09/06/2012