SIVAM DIABETES, NUTRITION AND FAMILY HEALTHCARE LLC (NPI# 1568974418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568974418 |
| Entity Type | Organization |
| Organization Name | SIVAM DIABETES, NUTRITION AND FAMILY HEALTHCARE LLC |
| Practice Address |
240 N Arlington Ave East Orange NJ 07017-3802 |
| Mailing Address |
78 Kenmore Avenue Newark NJ 07106 |
| Practice Telephone | 2016181472 |
| Mailing Telephone | 2016181472 |
| Mailing Fax Number | 9733993393 |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2017-11-01 |
| Authorized Official Name | DR. MAVIS CAMALITA FAULKNOR (CEO/SOCIAL ENTREPRENEUR) |
| Authorized Official Telephone | 2016181472 |
| Authorized Official Credential | FNP, APN, RN, RD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WD0400X |
Registered Nurse Specialization: Diabetes Educator |
26NR11201600 | NJ | Nursing Service Providers |
| N | 133VN1006X |
Dietitian, Registered Specialization: Nutrition, Metabolic |
0071705 | IL | Dietary & Nutritional Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
26NJ00421400 | NJ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
240 N ARLINGTON AVE |
| City | EAST ORANGE |
| State | NJ |
| Zip Code | 07017-3802 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710525662 | Sivam Diabetes & Primary Care LLC | Clinic/Center | 240 N Arlington Ave, East Orange, NJ 07017-3802 | 2019-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255993101 | Yvonne Jansen-pearce | Licensed Practical Nurse | 212 N Mum Ave., East Orange, NJ 07017 | 2019-07-01 |
| 1356821508 | Kinfolk Advanced Illness Nurse Practitioners | Nurse Practitioner | 16 Eastwood St, East Orange, NJ 07017 | 2018-08-17 |
| 1619490992 | Holy Hands Enterprises L.l.c | Home Health | 7 Glenwood Ave., Suite 419-b, 4th Floor., East Orange, NJ 07017 | 2017-07-19 |
| 1760902688 | Kenneth Amoah Gyan | Nurse Practitioner | 28a Melmore Gardens, East Orange, NJ 07017 | 2017-06-21 |
| 1487002192 | Robert William Reilly | Student in an Organized Health Care Education/Training Program | 344 Prospect Street, East Orange, NJ 07017 | 2016-06-03 |
| 1497114474 | Alicja U Pietrzak | Behavioral Analyst | 60 Evergreen Pl., 3rd Floor Suite 309, East Orange, NJ 07017 | 2016-02-18 |
| 1396147658 | Angela Gordon | Licensed Practical Nurse | 12 Lawton Street, East Orange, NJ 07017 | 2014-09-18 |
| 1063716488 | Yonas T Mehari | Specialist | 251 Hoffman Blvd, East Orange, NJ 07017 | 2010-12-28 |
| 1275833857 | Urban Healthcare Initiative Program Inc | Clinic/Center | 613 Park Avenue, East Orange, NJ 07017 | 2010-10-28 |
| 1881813285 | Trans America Care | Non-emergency Medical Transport (VAN) | 55 Washington Street, Suite# 308, East Orange, NJ 07017 | 2007-04-24 |
| Find all providers in zip 07017 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356821508 | Kinfolk Advanced Illness Nurse Practitioners | Nurse Practitioner | 16 Eastwood St, East Orange, NJ 07017 | 2018-08-17 |
| 1164911384 | Primerose Germain | Nurse Practitioner | 134 Evergreen Pl Ste 100, East Orange, NJ 07018-2019 | 2018-05-03 |
| 1760902688 | Kenneth Amoah Gyan | Nurse Practitioner | 28a Melmore Gardens, East Orange, NJ 07017 | 2017-06-21 |
| 1811430721 | Pearl Akwaja | Nurse Practitioner | 551 Norwood St, East Orange, NJ 07018-1035 | 2016-11-25 |
| 1558610667 | Caroline Uche Okonkwo | Nurse Practitioner | 444 Williams Street, East Orange, NJ 07017-2213 | 2012-09-05 |
| 1013552645 | Hana Michele Baron | Nurse Practitioner | 385 Tremont Ave, East Orange, NJ 07018-1023 | 2019-11-06 |
| 1215595764 | Stacyann Anderson | Nurse Practitioner | 220 S Harrison St, East Orange, NJ 07018-1401 | 2019-05-30 |
| 1407332687 | Marie S Tunis | Nurse Practitioner | 60 Evergreen Place, Suite 400, East Orange, NJ 07018 | 2018-07-11 |
| 1720584956 | Nmandu O Utuk | Nurse Practitioner | 60 Evergreen Place, Suite 400, East Orange, NJ 07018 | 2018-04-05 |
| 1639612898 | Chinwe Winifred Obasi | Nurse Practitioner | 385 Tremont Avenue, East Orange, NJ 07018 | 2016-11-21 |
| Find all providers in EAST ORANGE | ||||
| City | EAST ORANGE |
| Zip Code | 07017 |
Please comment or provide details below to improve the information on SIVAM DIABETES, NUTRITION AND FAMILY HEALTHCARE LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.