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General NPI Number Information
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NPI Number | 1972728327
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Entity Type | Organization
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Legal Business Name | COLMEXI MEDICAL, LLC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 805 11TH STREET
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City | UNION CITY
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State | NJ
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Zip | 07087-6203
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Country | US
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Telephone | 201-866-8533
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Fax | 201-866-6994
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Provider Business Mailing Address
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Address Line | 1085 FRANKLIN LAKES ROAD
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City | FRANKLIN LAKES
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State | NJ
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Zip | 07417-1131
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Country | US
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Telephone | 201-866-8533
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Fax | 201-866-6994
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. BENJAMIN ANTONIO SABIDO
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Credential | M.D
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Telephone | 201-866-8533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA07696900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 25MA07696900
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License Number State | NJ
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