Healthcare Provider Details

I. General information

NPI: 1023449238
Provider Name (Legal Business Name): NECHAMA OPPENHEIMER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CHESTNUT ST UNIT 3
LAKEWOOD NJ
08701-5894
US

IV. Provider business mailing address

40 CHESTNUT ST UNIT 3
LAKEWOOD NJ
08701-5894
US

V. Phone/Fax

Practice location:
  • Phone: 732-833-3723
  • Fax:
Mailing address:
  • Phone: 732-833-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number46TR00506000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: