Healthcare Provider Details

I. General information

NPI: 1174768048
Provider Name (Legal Business Name): DR. JUSTYNA OBARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. JUSTYNA ADAMCZYK

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 W SHERMAN AVE
VINELAND NJ
08360-6913
US

IV. Provider business mailing address

785 W SHERMAN AVE
VINELAND NJ
08360-6913
US

V. Phone/Fax

Practice location:
  • Phone: 856-451-4700
  • Fax:
Mailing address:
  • Phone: 856-451-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08551400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: