Healthcare Provider Details

I. General information

NPI: 1790303428
Provider Name (Legal Business Name): OZIMS PRIMARY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 UNION ST
LINDEN NJ
07036-2554
US

IV. Provider business mailing address

625 UNION ST
LINDEN NJ
07036-2554
US

V. Phone/Fax

Practice location:
  • Phone: 201-878-6442
  • Fax:
Mailing address:
  • Phone: 201-878-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IKENNA MADUFOR OZIMS
Title or Position: CO-OWNER
Credential: MD
Phone: 201-878-6442