Provider Demographics
NPI:1396103289
Name:BFIT4EVER
Entity type:Organization
Organization Name:BFIT4EVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANAH
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:609-345-1897
Mailing Address - Street 1:170 N MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-5546
Mailing Address - Country:US
Mailing Address - Phone:609-345-1897
Mailing Address - Fax:
Practice Address - Street 1:6 N MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-4013
Practice Address - Country:US
Practice Address - Phone:609-340-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18143000261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service