Provider Demographics
NPI:1811990047
Name:NBN INFUSIONS INC
Entity type:Organization
Organization Name:NBN INFUSIONS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOETTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:856-669-0217
Mailing Address - Street 1:2 PIN OAK LN
Mailing Address - Street 2:UNIT 250
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1632
Mailing Address - Country:US
Mailing Address - Phone:856-669-0217
Mailing Address - Fax:856-520-8067
Practice Address - Street 1:2 PIN OAK LN
Practice Address - Street 2:UNIT 250
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1632
Practice Address - Country:US
Practice Address - Phone:856-669-0217
Practice Address - Fax:856-520-8067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336H0001X, 3336S0011X, 332BX2000X, 3336C0004X, 3336C0003X, 332BP3500X, 332B00000X
NJ28RS00454200333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055764OtherPK
DE000556916Medicaid
PA001241395004Medicaid
NJ3447600Medicaid
NJ4533402Medicaid
PA001241395004Medicaid