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Organization
NJ SOUTH COAST MEDICAL CENTER CORP
Active
Organization
NJ SOUTH COAST MEDICAL CENTER CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBERE EZEANYA MD (MEDICAL DIRECTOR)
(973) 704-5644
Entity
Organization
Contact information
Practice address
37 MAIN ST STE 5, CLINTON, NJ 08809
(609) 582-0899
Mailing address
4995 DERBY LN, BETHLEHEM, PA 18020-9418
(973) 704-5644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA09219400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0357367
—
NJ
Enumeration date
10/15/2013
Last updated
08/21/2019
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