Provider Demographics
NPI:1982296711
Name:BLUEBERRY MEDICAL OF NEW JERSEY PA
Entity Type:Organization
Organization Name:BLUEBERRY MEDICAL OF NEW JERSEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:754-702-7256
Mailing Address - Street 1:34 SHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3809
Mailing Address - Country:US
Mailing Address - Phone:407-497-9203
Mailing Address - Fax:
Practice Address - Street 1:180 TALMADGE RD UNIT 349
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2860
Practice Address - Country:US
Practice Address - Phone:754-702-7256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty