Provider Demographics
NPI:1336374354
Name:ST BARNABAS MEDICAL CENTER
Entity Type:Organization
Organization Name:ST BARNABAS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STUDENT IN TRAINING
Authorized Official - Prefix:
Authorized Official - First Name:NURLELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUVEIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-512-9406
Mailing Address - Street 1:14 N BEVERWYCK RD
Mailing Address - Street 2:APT # 3
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-2517
Mailing Address - Country:US
Mailing Address - Phone:405-512-9406
Mailing Address - Fax:
Practice Address - Street 1:14 N BEVERWYCK RD
Practice Address - Street 2:APT # 3
Practice Address - City:LAKE HIAWATHA
Practice Address - State:NJ
Practice Address - Zip Code:07034-2517
Practice Address - Country:US
Practice Address - Phone:405-512-9406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty