Provider Demographics
NPI:1649402082
Name:BEIZEM, JOANNA (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BEIZEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 MADISON AVENUE
Mailing Address - Street 2:CENTER FOR HEALTLH EDUCATION, MEDICINE AND DENTISTRY
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1251
Mailing Address - Country:US
Mailing Address - Phone:732-364-2144
Mailing Address - Fax:732-364-3559
Practice Address - Street 1:1771 MADISON AVENUE
Practice Address - Street 2:CENTER FOR HEALTLH EDUCATION, MEDICINE AND DENTISTRY
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1251
Practice Address - Country:US
Practice Address - Phone:732-364-2144
Practice Address - Fax:732-364-3559
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08637200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics