Provider Demographics
NPI:1891080040
Name:DIABETES CONCEPTS- LLC
Entity Type:Organization
Organization Name:DIABETES CONCEPTS- LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:OZURUMBA
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:848-237-9715
Mailing Address - Street 1:1075 EASTON AVE STE 11-258
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1648
Mailing Address - Country:US
Mailing Address - Phone:848-237-9715
Mailing Address - Fax:
Practice Address - Street 1:1075 EASTON AVE STE 11-258
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1648
Practice Address - Country:US
Practice Address - Phone:848-237-9715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0250376Medicaid