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General NPI Number Information
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NPI Number | 1659882082
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Entity Type | Organization
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Legal Business Name | BMG EAST ORANGE LLC
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 200 FREEWAY DR E STE 305
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City | EAST ORANGE
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State | NJ
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Zip | 07018
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Country | US
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Telephone | 973-370-4000
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Fax | 973-370-4040
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Provider Business Mailing Address
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Address Line | 200 FREEWAY DR E STE 305
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City | EAST ORANGE
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State | NJ
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Zip | 07018-3809
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Country | US
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Telephone | 973-370-4000
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Fax | 862-904-0044
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Authorized Official
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Title or Position | BILLING & CREDENTIALING DIRECTOR
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Name | MS. BLIMY JACOBS
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Credential | CREDENTIAL
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Telephone | 845-662-2404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 25MA08818300
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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 | 25MA08818300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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