Provider Demographics
NPI:1437614393
Name:FREEDOM MEDICAL CLINICS
Entity Type:Organization
Organization Name:FREEDOM MEDICAL CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEADOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-478-8600
Mailing Address - Street 1:304 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-4069
Mailing Address - Country:US
Mailing Address - Phone:973-478-8600
Mailing Address - Fax:973-478-8601
Practice Address - Street 1:304 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4069
Practice Address - Country:US
Practice Address - Phone:973-478-8600
Practice Address - Fax:973-478-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA07345200OtherNJ LICENSE