Healthcare Provider Details

I. General information

NPI: 1528728375
Provider Name (Legal Business Name): BIOFOURMIS CARE NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 BEAR TAVERN RD
EWING NJ
08628-1021
US

IV. Provider business mailing address

33 ARCH ST
BOSTON MA
02110-1424
US

V. Phone/Fax

Practice location:
  • Phone: 855-770-7771
  • Fax: 855-770-7771
Mailing address:
  • Phone: 310-626-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEVION SMITH
Title or Position: DIRECTOR, PAYER CONTRACTING
Credential:
Phone: 424-326-8711