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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