Basic Information
| Provider Information | |||||||||
| NPI: | 1417064973 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLUEBOND | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 EARLIN AVE STE 290 | ||||||||
| Address2: | |||||||||
| City: | BROWNS MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080151780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095377200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6 EARLIN AVE | ||||||||
| Address2: | STE 290 | ||||||||
| City: | BROWNS MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095377200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 05/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | OS004744L | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0010067890005 | 05 | PA | MEDICAID |