Healthcare Provider Details

I. General information

NPI: 1295900587
Provider Name (Legal Business Name): UNIMED CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 STATE ROUTE 18 STE 202
EAST BRUNSWICK NJ
08816-1407
US

IV. Provider business mailing address

190 STATE ROUTE 18 STE 202
EAST BRUNSWICK NJ
08816-1407
US

V. Phone/Fax

Practice location:
  • Phone: 732-828-9988
  • Fax: 732-828-1010
Mailing address:
  • Phone: 732-828-9988
  • Fax: 732-828-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number25MA09132400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number006694-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number25MA07506100
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07506100
License Number StateNJ

VIII. Authorized Official

Name: DR. JENNY H.Y. LIU
Title or Position: OWNER
Credential: M.D., M.S.
Phone: 732-828-9988