Organization
NBIMC FAMILY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHARMAINE THOMAS (DIRECTOR)
(732) 557-7160
Entity
Organization
Contact information
Practice address
166 LYONS AVE, NEWARK, NJ 07112-2016
(973) 926-7300
(973) 923-9506
Mailing address
PO BOX 18788, NEWARK, NJ 07191-8788
(732) 557-7160
(732) 557-7109
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8249407
—
NJ
Enumeration date
05/03/2006
Last updated
04/22/2008
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