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General NPI Number Information
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NPI Number | 1417185711
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICAL CENTER OF BAYONNE,LLC
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 449 AVENUE C
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City | BAYONNE
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State | NJ
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Zip | 07002-5105
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Country | US
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Telephone | 201-823-2334
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Fax | 201-823-2344
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Provider Business Mailing Address
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Address Line | 42 QUARRY DR
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City | WEST PATERSON
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State | NJ
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Zip | 07424-4201
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Country | US
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Telephone | 917-991-1220
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | DR. JUANITA JENYONS
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Credential | MD
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Telephone | 917-991-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA08448100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MA0033221
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License Number State | NJ
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