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General NPI Number Information
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NPI Number | 1962726505
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Entity Type | Organization
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Legal Business Name | BELDER ADVANCED MEDICAL LLC
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Dates
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Enumeration Date | 03/25/2010
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 4122 ROUTE 516
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City | MATAWAN
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State | NJ
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Zip | 07747-7022
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Country | US
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Telephone | 732-264-1163
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Fax | 732-264-3580
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Provider Business Mailing Address
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Address Line | 4122 ROUTE 516
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City | MATAWAN
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State | NJ
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Zip | 07747-7022
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Country | US
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Telephone | 732-264-1163
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Fax | 732-264-3580
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Authorized Official
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Title or Position | OWNER
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Name | OLGA BELDER
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Credential | DO
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Telephone | 732-264-1163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MB07299600
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License Number State | NJ
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