Sivam Diabetes, Nutrition And Family Healthcare

LBN: Sivam Diabetes & Primary Care Llc
Sivam Diabetes, Nutrition And Family Healthcare is an health care organization with primary practice located at 1120-1122 South Orange Avenue , Newark NJ 07106. The organization recently has 4 registered licenses in different health care specialties including Dietary & Nutritional Service Providers / Dietitian, Registered, Nursing Service Providers / Diabetes Educator, Ambulatory Health Care Facilities / Health Service, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is the primary health care specialty. Sivam Diabetes & Primary Care Llc can be contacted via phone (201) 618-1472, or through Ermakov, Mavis Camalita via phone (201) 618-1472.

Contact Information

Primary practice address
1120-1122 South Orange Avenue Newark NJ 07106
Phone: (201) 618-1472
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Ermakov, Mavis Camalita DNP, APN, FHNP-BC, R
Phone: (201) 618-1472

Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X
Nursing Service Providers / Diabetes Educator 163WD0400X
Ambulatory Health Care Facilities / Health Service 261QH0100X
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X

Profile Details

NPI number 1710525662
LBN Legal business name Sivam Diabetes & Primary Care Llc
DBA Doing business as Sivam Diabetes, Nutrition And Family Healthcare
Authorized official Ermakov, Mavis Camalita DNP, APN, FHNP-BC, R
Entity Organization
Organization subpart 1 No
Enumeration date Dec 11th, 2019
Last updated Sep 1st, 2021 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710525662 NPPES
New Jersey MEDICAID 0143533620

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