Individual
SHAZAM BACCHUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APN
Contact information
Practice address
459 N 7TH ST FL 1, NEWARK, NJ 07107-3743
(973) 388-9560
Mailing address
459 N 7TH ST FL 1, NEWARK, NJ 07107-3743
(973) 388-9560
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
26NJ01004000
NJ
Other
Enumeration date
01/24/2020
Last updated
01/24/2020
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