South Jersey Sports & Spine Medicine LLC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

Legal business name

SOUTH JERSEY SPORTS & SPINE MEDICINE LLC

Practice address

525 Route 73 South
Evesham Commons- Suite 104a
Marlton, NJ 08053-9643

Phone

(856) 874-9777

Fax

(856) 874-9444

NPI assigned

Jul 25, 2006

Organization subpart

No

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

Authorized official

Name

Meryl Y Stein, MD

Title

Owner

Phone

(856) 874-9777

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Irene Mizobe Connolly X, PT, MS

  • Physical Therapist
  • Philadelphia, PA
  • NPI 1518034925
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287964800000",
    "number": "1588686604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22462",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191102462",
            "telephone_number": "215-732-7600",
            "fax_number": "856-874-9444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 ROUTE 73 SOUTH",
            "address_2": "EVESHAM COMMONS- SUITE 104A",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080539643",
            "telephone_number": "856-874-9777",
            "fax_number": "856-874-9444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH JERSEY SPORTS & SPINE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2010-10-25",
        "status": "A",
        "authorized_official_last_name": "STEIN",
        "authorized_official_first_name": "MERYL",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-874-9777",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "2625614000",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR",
            "identifier": "610782200",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0075728",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Jersey Fertility, LLC
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• South Jersey Pain Consultants, LLC
• South Jersey Skin Care & Laser Center, P.C.
• South Jersey Urogynecology, LLC
• South Jersey Wellness Center
• Liana Soyfer, APN
• Keisha Katrice Sparrow, MA, LPC
• Eileen Spaugh

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.