# PREMIER ORTHOPAEDIC & SPORTS MEDICINE ASSOC OF SOUTHERN NJ LLC

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

## Provider details

- **NPI number:** 1699261388
- **Authorized official:** VERNA SHEPHERD (ADMINISTRATOR OF PHYSICIAN SERVICES)
- **Authorized official phone:** (856) 690-1616

## Contact information

- **Practice address:** 200 ROWAN BLVD, GLASSBORO, NJ 08028
- **Practice address phone:** (856) 690-1616
- **Practice address fax:** (856) 690-1089
- **Mailing address:** 352 S DELSEA DR STE C, VINELAND, NJ 08360-5306
- **Mailing address phone:** (856) 690-1616
- **Mailing address fax:** (856) 690-1089

## Taxonomy

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

## Other

- **Enumeration date:** 07/05/2018
- **Last updated:** 04/29/2020