Provider Demographics
NPI:1205222692
Name:IBEAM MEDICAL NEW JERSEY, LLC
Entity Type:Organization
Organization Name:IBEAM MEDICAL NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-214-4656
Mailing Address - Street 1:253 MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:253 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3222
Practice Address - Country:US
Practice Address - Phone:866-214-4656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies