NPIMap

Organization Active NPI

Complete Care of South Jersey

  • Nephrology Physician
  • Salem, NJ
National Provider Identifier
1518320555
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
25MA06336400 Issued in NJ
Legal business name
COMPLETE CARE OF SOUTH JERSEY
Practice address
4 Bypass Rd Ste 104
Salem, NJ 08079-2053
Phone
(856) 887-3005
Fax
(856) 759-4035
NPI assigned
Mar 29, 2016
Last updated
Oct 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Wamiq Sultan, MDNPI 1699873463
Title
Owner
Phone
(856) 887-3005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 26NJ00328900 NJ
Nephrology Physician 207RN0300X 25MA06336400 NJ Primary

Addresses

Primary practice location

4 Bypass Rd Ste 104
Salem, NJ 08079-2053

Mailing address

4 Bypass Rd Ste 104
Salem, NJ 08079-2053
Phone (856) 887-3005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160615001232 NJ Part B Supplier - Clinic/Group Practice 8820389257 Receives reassigned benefits from 11 practitioners
Practice locations: Salem, NJ; Woodbury, NJ

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

4 Bypass Rd
Ste 104
Salem, NJ 08079
Phone (856) 887-3005

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1518320555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 BYPASS RD STE 104",
            "city": "SALEM",
            "state": "NJ",
            "postal_code": "080792053",
            "telephone_number": "856-887-3005",
            "fax_number": "856-759-4035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 BYPASS RD STE 104",
            "city": "SALEM",
            "state": "NJ",
            "postal_code": "080792053",
            "telephone_number": "856-887-3005",
            "fax_number": "856-759-4035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE CARE OF SOUTH JERSEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-29",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "SULTAN",
        "authorized_official_first_name": "WAMIQ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-887-3005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NJ",
            "license": "26NJ00328900",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "25MA06336400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.