MEDICARE: COLMEXI MEDICAL, LLC

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	174400000X	Specialist	25MA07696900	NJ
2	261Q00000X	Clinic/Center	25MA07696900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972728327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLMEXI MEDICAL, LLC

Provider Business Mailing Address
First Line	:	1085 FRANKLIN LAKES ROAD
Second Line	:
City	:	FRANKLIN LAKES
State	:	NJ
Zip	:	07417-1131
Country	:	US
Telephone Number	:	201-866-8533
Fax Number	:	201-866-6994

Provider Business Practice Location Address
First Line	:	805 11TH STREET
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-6203
Country	:	US
Telephone Number	:	201-866-8533
Fax Number	:	201-866-6994

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. BENJAMIN ANTONIO SABIDO
Credential	:	M.D
Telephone Number	:	201-866-8533

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	10/31/2012

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Directions to “COLMEXI MEDICAL, LLC ” Practice Location

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