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General NPI Number Information
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NPI Number | 1861534323
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Entity Type | Individual
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Provider Name | VIMALA BENNY GEORGE ANP-C
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1777 LAWRENCE ST
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City | RAHWAY
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State | NJ
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Zip | 07065-5111
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Country | US
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Telephone | 732-499-7927
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Fax | 732-396-1298
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Provider Business Mailing Address
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Address Line | 715 SANDOR CT
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City | PARAMUS
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State | NJ
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Zip | 07652-4028
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Country | US
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Telephone | 201-634-8733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00006200
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License Number State | NJ
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