Provider Demographics
NPI:1376939199
Name:BLESSED FAMILY CARE CONSULTANTS LLC
Entity Type:Organization
Organization Name:BLESSED FAMILY CARE CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FADIPE
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C
Authorized Official - Phone:862-576-2061
Mailing Address - Street 1:146 STUYVESANT AVE
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-2508
Mailing Address - Country:US
Mailing Address - Phone:862-576-2061
Mailing Address - Fax:
Practice Address - Street 1:34 UNION AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3219
Practice Address - Country:US
Practice Address - Phone:862-217-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00468500261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ360560Medicare PIN