Healthcare Provider Details

I. General information

NPI: 1639995483
Provider Name (Legal Business Name): ELIZABETH HUAMANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 US HIGHWAY 9
OLD BRIDGE NJ
08857-2691
US

IV. Provider business mailing address

416 W 5TH AVE
ROSELLE NJ
07203-1858
US

V. Phone/Fax

Practice location:
  • Phone: 908-377-2417
  • Fax:
Mailing address:
  • Phone: 908-377-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number22HI01275000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: