Healthcare Provider Details

I. General information

NPI: 1174103527
Provider Name (Legal Business Name): ALINA BEJARAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2021
Last Update Date: 01/18/2022
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 S WHITE HORSE PIKE
HAMMONTON NJ
08037-2018
US

IV. Provider business mailing address

1 N WHITE HORSE PIKE
HAMMONTON NJ
08037-1875
US

V. Phone/Fax

Practice location:
  • Phone: 609-567-0200
  • Fax: 609-567-1951
Mailing address:
  • Phone: 609-567-0434
  • Fax: 609-567-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00661800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: