SIVAM DIABETES & PRIMARY CARE LLC NPI 1710525662

NPI Information

SIVAM DIABETES & PRIMARY CARE LLC is a family nurse practitioner in Newark, NJ. SIVAM DIABETES & PRIMARY CARE LLC NPI is 1710525662. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Sivam Diabetes, Nutrition And Family Healthcare.

The provider's business location address is:

1120-1122 SOUTH ORANGE AVENUE
NEWARK, NJ
ZIP 07106
Phone: (201) 618-1472

The provider's authorized official is Mavis Camalita Ermakov .
The authorized official title is Director/ceo and has the following contact phone number (201) 618-1472.

The CLIA number assigned to this NPI record is 31D2236684 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/11/2019 and was last updated on 9/1/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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