Provider Demographics
NPI:1790597490
Name:MEDIGENCE HEALTH NJ, PC
Entity type:Organization
Organization Name:MEDIGENCE HEALTH NJ, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNERS
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUSOLA
Authorized Official - Middle Name:ABIYE
Authorized Official - Last Name:BRIMMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-836-0510
Mailing Address - Street 1:10960 WILSHIRE BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10960 WILSHIRE BLVD STE 406
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3704
Practice Address - Country:US
Practice Address - Phone:888-836-0510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty