Healthcare Provider Details

I. General information

NPI: 1144288366
Provider Name (Legal Business Name): NBIMC TRINITAS PEDIATRIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WILLIAMSON ST
ELIZABETH NJ
07202-3625
US

IV. Provider business mailing address

PO BOX 15314
NEWARK NJ
07192-5314
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5452
  • Fax: 908-351-7930
Mailing address:
  • Phone: 732-557-7160
  • Fax: 732-557-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ANTHONY ESPOSITO
Title or Position: DIRECTOR
Credential:
Phone: 732-557-7160