Healthcare Provider Details

I. General information

NPI: 1962726505
Provider Name (Legal Business Name): BELDER ADVANCED MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 ROUTE 516
MATAWAN NJ
07747-7022
US

IV. Provider business mailing address

4122 ROUTE 516
MATAWAN NJ
07747-7022
US

V. Phone/Fax

Practice location:
  • Phone: 732-264-1163
  • Fax: 732-264-3580
Mailing address:
  • Phone: 732-264-1163
  • Fax: 732-264-3580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB07299600
License Number StateNJ

VIII. Authorized Official

Name: OLGA BELDER
Title or Position: OWNER
Credential: DO
Phone: 732-264-1163