Healthcare Provider Details

I. General information

NPI: 1902083793
Provider Name (Legal Business Name): NBIMC-FP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE
NEWARK NJ
07112-2027
US

IV. Provider business mailing address

201 LYONS AVE L5
NEWARK NJ
07112-2027
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-7475
  • Fax: 973-318-7207
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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: GALINA M BEGUN
Title or Position: CREDENTIALING MANAGER
Credential: CPCS, CPMSM
Phone: 732-557-7119