Provider Demographics
NPI:1447405253
Name:NEWARK BETH ISRAEL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:NEWARK BETH ISRAEL MEDICAL CENTER INC
Other - Org Name:NBIMC REGIONAL DIAGNOSTIC AND TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEGUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-557-7119
Mailing Address - Street 1:166 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2016
Mailing Address - Country:US
Mailing Address - Phone:732-557-7119
Mailing Address - Fax:732-557-7119
Practice Address - Street 1:166 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2016
Practice Address - Country:US
Practice Address - Phone:732-557-7119
Practice Address - Fax:732-557-7119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWARK BETH ISRAEL MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0051888Medicaid