NPIMap

Organization Active NPI

Sicklerville Internal Medicine

  • Internal Medicine Physician
  • Laurel Springs, NJ
National Provider Identifier
1821045428
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SICKLERVILLE INTERNAL MEDICINE
Practice address
1405 Chews Landing Rd
Ste. 14
Laurel Springs, NJ 08021-2769
Phone
(856) 227-6575
Fax
(856) 374-9495
NPI assigned
May 28, 2006
Last updated
Nov 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Authorized official

Name
Ms. Joan Wensauer, BA
Title
Credentialing Consultant
Phone
(856) 782-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

1405 Chews Landing Rd
Ste. 14
Laurel Springs, NJ 08021-2769

Mailing address

1405 Chews Landing Rd
Ste. 14
Laurel Springs, NJ 08021-2769
Phone (856) 227-6575

Other identifiers 1

IdentifierTypeStateIssuer
3279600MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Sicklerville Internal Medicine3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

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": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1821045428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 CHEWS LANDING RD",
            "address_2": "STE. 14",
            "city": "LAUREL SPRINGS",
            "state": "NJ",
            "postal_code": "080212769",
            "telephone_number": "856-227-6575",
            "fax_number": "856-374-9495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 CHEWS LANDING RD",
            "address_2": "STE. 14",
            "city": "LAUREL SPRINGS",
            "state": "NJ",
            "postal_code": "080212769",
            "telephone_number": "856-227-6575",
            "fax_number": "856-374-9495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SICKLERVILLE INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "WENSAUER",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "CREDENTIALING CONSULTANT",
        "authorized_official_telephone_number": "856-782-3300",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3279600",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel Springs, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; 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.