MEDICARE: BELUGA HEALTH PC OF NEW JERSEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1033823703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELUGA HEALTH PC OF NEW JERSEY

Provider Business Mailing Address
First Line	:	1321 UPLAND DR STE 18399
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-4718
Country	:	US
Telephone Number	:	224-484-0496
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 BERRHILL DR # 8094
Second Line	:
City	:	WILLIAMSTOWN
State	:	NJ
Zip	:	08094-3669
Country	:	US
Telephone Number	:	224-484-0496
Fax Number	:	888-960-2494

Authorized Official
Title or Position	:	CEO
Name	:	JONAH MINK
Credential	:	MD
Telephone Number	:	224-484-0499

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	02/08/2023

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