Healthcare Provider Details

I. General information

NPI: 1982296711
Provider Name (Legal Business Name): BLUEBERRY MEDICAL OF NEW JERSEY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 TALMADGE RD UNIT 349
EDISON NJ
08817-2860
US

IV. Provider business mailing address

34 SHERLAND AVE
MOUNTAIN VIEW CA
94043-3809
US

V. Phone/Fax

Practice location:
  • Phone: 754-702-7256
  • Fax:
Mailing address:
  • Phone: 407-497-9203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LYNDSEY GARBI
Title or Position: OWNER / PRESIDENT
Credential: MD
Phone: 754-702-7256