Provider Demographics
NPI:1659444727
Name:NEW LIFE MEDICAL
Entity Type:Organization
Organization Name:NEW LIFE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ZARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDELBLAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-892-6141
Mailing Address - Street 1:PO BOX 351154
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8954
Mailing Address - Country:US
Mailing Address - Phone:917-892-6141
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY # 803
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2920
Practice Address - Country:US
Practice Address - Phone:917-892-6141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ137887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0068713Medicaid
NY0068713Medicaid
NY091036Medicare ID - Type Unspecified