Healthcare Provider Details

I. General information

NPI: 1184692261
Provider Name (Legal Business Name): MICHAEL ELLIOT BEAMS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 WALNUT AVE
CLARK NJ
07066-1640
US

IV. Provider business mailing address

67 WALNUT AVE
CLARK NJ
07066-1640
US

V. Phone/Fax

Practice location:
  • Phone: 732-388-7300
  • Fax: 732-388-1330
Mailing address:
  • Phone: 732-388-7300
  • Fax: 732-388-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMB27483
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: