Healthcare Provider Details

I. General information

NPI: 1811697329
Provider Name (Legal Business Name): NEWTON BEAUREGARD PARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 STATE ROUTE 94
BLAIRSTOWN NJ
07825-2114
US

IV. Provider business mailing address

50 MOTT RD
BLAIRSTOWN NJ
07825-4128
US

V. Phone/Fax

Practice location:
  • Phone: 908-362-6963
  • Fax:
Mailing address:
  • Phone: 908-674-4786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number28RW04657700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: