Healthcare Provider Details

I. General information

NPI: 1447749262
Provider Name (Legal Business Name): NICOLE BEJIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 02/02/2024
Certification Date: 05/17/2021
Deactivation Date: 01/25/2024
Reactivation Date: 02/02/2024

III. Provider practice location address

21 MOHAWK AVE
SPARTA NJ
07871-1808
US

IV. Provider business mailing address

21 MOHAWK AVE
SPARTA NJ
07871-1808
US

V. Phone/Fax

Practice location:
  • Phone: 973-729-4211
  • Fax:
Mailing address:
  • Phone: 973-729-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00818700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: