MEDICARE: SIBAVEN MEDICAL ASSOCIATES AND LOGISTICS

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1932917713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIBAVEN MEDICAL ASSOCIATES AND LOGISTICS

Provider Business Mailing Address
First Line	:	525 ROUTE 73 N STE 104
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-3422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 MORRIS AVE STE C202
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-5747
Country	:	US
Telephone Number	:	240-421-5451
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALBERT KWIMI
Credential	:
Telephone Number	:	302-590-0144

Provider Enumeration Date	:	12/24/2024
Last Update Date	:	02/09/2026

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