Provider Demographics
NPI:1942748983
Name:SBMC PROVIDER SERVICES
Entity Type:Organization
Organization Name:SBMC PROVIDER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-423-7497
Mailing Address - Street 1:95 OLD SHORT HILLS RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1008
Mailing Address - Country:US
Mailing Address - Phone:732-423-7497
Mailing Address - Fax:
Practice Address - Street 1:95 OLD SHORT HILLS RD
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1008
Practice Address - Country:US
Practice Address - Phone:732-423-7497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty