Healthcare Provider Details

I. General information

NPI: 1336374354
Provider Name (Legal Business Name): ST BARNABAS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 N BEVERWYCK RD APT # 3
LAKE HIAWATHA NJ
07034-2517
US

IV. Provider business mailing address

14 N BEVERWYCK RD APT # 3
LAKE HIAWATHA NJ
07034-2517
US

V. Phone/Fax

Practice location:
  • Phone: 405-512-9406
  • Fax:
Mailing address:
  • Phone: 405-512-9406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: NURLELA GOUVEIA
Title or Position: STUDENT IN TRAINING
Credential: M.D
Phone: 405-512-9406