Healthcare Provider Details

I. General information

NPI: 1114985702
Provider Name (Legal Business Name): NBIMC DEPARTMENT OF INTERNAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE
NEWARK NJ
07112-2027
US

IV. Provider business mailing address

PO BOX 18491
NEWARK NJ
07191-8491
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-7472
  • Fax: 973-923-8063
Mailing address:
  • Phone: 732-557-7119
  • Fax: 732-557-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. YASMIR BISAL
Title or Position: DIRECTOR
Credential:
Phone: 732-557-7119