Bambara, Vivion Larry

Bambara, Vivion Larry is an sole proprietor health care provider with primary practice located at 101 E Gibbsboro Rd Apt 1611 , Lindenwold NJ 08021-1923. He recently has 3 registered licenses in different health care specialties including Agencies / Day Training, Developmentally Disabled Services, Ambulatory Health Care Facilities / Adult Day Care, Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities. Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities is his primary health care specialty. Bambara, Vivion Larry can be contacted via phone (346) 262-7732.

Contact Information

Primary practice address
101 E Gibbsboro Rd Apt 1611 Lindenwold NJ 08021-1923
Phone: (346) 262-7732
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Agencies / Day Training, Developmentally Disabled Services 251C00000X
Ambulatory Health Care Facilities / Adult Day Care 261QA0600X
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320900000X New Jersey

Profile Details

NPI number 1649857186
LBN Legal business name Bambara, Vivion Larry
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 29th, 2021
Last updated Jan 1st, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649857186 NPPES
New Jersey MEDICAID 1649857186

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