Provider Demographics
NPI:1811463086
Name:NEW LIFE MEDICAL LLC
Entity type:Organization
Organization Name:NEW LIFE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRITICAL CARE MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:NEBIYU
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-939-7248
Mailing Address - Street 1:3025 NASSAU DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3311
Practice Address - Country:US
Practice Address - Phone:703-523-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty