Healthcare Provider Details
I. General information
NPI: 1982967121
Provider Name (Legal Business Name): LYNSEY MARIE BEAMS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/22/2012
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
34 COLSON LN
MULLICA HILL NJ
08062-1502
US
IV. Provider business mailing address
PO BOX 22581
NEW YORK NY
10087-2581
US
V. Phone/Fax
- Phone: 856-223-8930
- Fax:
- Phone: 610-482-4795
- Fax: 856-528-3117
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207V00000X |
| Taxonomy | Obstetrics & Gynecology Physician |
| License Number | 25MB09819500 |
| License Number State | NJ |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: