Provider Demographics
NPI:1174877757
Name:S.O.B HEALTH SYSTEM LLC
Entity type:Organization
Organization Name:S.O.B HEALTH SYSTEM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EBENEZER
Authorized Official - Middle Name:O-A
Authorized Official - Last Name:BILEWU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-573-5310
Mailing Address - Street 1:335 E JIMMIE LEEDS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4127
Mailing Address - Country:US
Mailing Address - Phone:609-573-5310
Mailing Address - Fax:609-241-1922
Practice Address - Street 1:335 E JIMMIE LEEDS RD
Practice Address - Street 2:SUITE A
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4127
Practice Address - Country:US
Practice Address - Phone:609-573-5310
Practice Address - Fax:609-241-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00702600261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3893359000OtherAMERIHEALTH NEW JERSEY
NJ389360000OtherAMERIHEALTH NEW JERSEY
NJ60114338OtherHORIZON NJ HEALTH
NJ389360000OtherAMERIHEALTH NEW JERSEY