Basic Information
| Provider Information | |||||||||
| NPI: | 1861534323 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | VIMALA | ||||||||
| MiddleName: | BENNY | ||||||||
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| Credential: | ANP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 SANDOR CT | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076524028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016348733 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1777 LAWRENCE ST | ||||||||
| Address2: | |||||||||
| City: | RAHWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070655111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324997927 | ||||||||
| FaxNumber: | 7323961298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 26NJ00006200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.