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General NPI Number Information
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NPI Number | 1134086101
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Entity Type | Organization
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Legal Business Name | BLUE MEDICAL DIAGNOSTICS EAST
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 176B COURT ST
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City | NEWARK
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State | NJ
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Zip | 07103-3820
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Country | US
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Telephone | 833-363-3258
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Fax |
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Provider Business Mailing Address
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Address Line | 176B COURT ST
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City | NEWARK
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State | NJ
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Zip | 07103-3820
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SYVON EVANS
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Credential |
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Telephone | 833-363-3258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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