Basic Information
| Provider Information | |||||||||
| NPI: | 1992753115 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NICU ASSOCIATES AT SAINT BARNABAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18220 | ||||||||
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| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071918220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325577160 | ||||||||
| FaxNumber: | 7325577109 | ||||||||
| Practice Location | |||||||||
| Address1: | 94 OLD SHORT HILLS RD | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070395672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733225437 | ||||||||
| FaxNumber: | 9733228833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ESPOSITO | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7325577160 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5223806 | 05 | NJ | MEDICAID |