MEDICARE: EUNICE O BAMGBADE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	26NR11500400	NJ

General Provider Information

NPI Number	:	1053842260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNICE O BAMGBADE

Provider Business Mailing Address
First Line	:	404 CLIFTON AVE
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07011-2614
Country	:	US
Telephone Number	:	856-426-9520
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 CLIFTON AVE
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07011-2614
Country	:	US
Telephone Number	:	856-426-9520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/21/2017

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Directions to “ EUNICE O BAMGBADE ” Practice Location

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