Healthcare Provider Details

I. General information

NPI: 1609114628
Provider Name (Legal Business Name): UNIVERSITY MEDICAL OFFICE NJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 LINDEN ST
HACKENSACK NJ
07601-3554
US

IV. Provider business mailing address

56 LINDEN ST
HACKENSACK NJ
07601-3554
US

V. Phone/Fax

Practice location:
  • Phone: 551-333-3456
  • Fax: 646-393-9081
Mailing address:
  • Phone: 551-333-3456
  • Fax: 646-393-9081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08476500
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CHRISTIAN ARTURO BELLIARD ESTEVEZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 551-333-3456