Provider Demographics
NPI:1538302138
Name:TAYLOR, BELLAZMIN NATALIE (MS-PA-C)
Entity type:Individual
Prefix:MS
First Name:BELLAZMIN
Middle Name:NATALIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS-PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:354 DOREMUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104
Mailing Address - Country:US
Mailing Address - Phone:973-274-6816
Mailing Address - Fax:917-274-6996
Practice Address - Street 1:354 DOREMUS AVENUE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104
Practice Address - Country:US
Practice Address - Phone:973-274-6816
Practice Address - Fax:917-274-6996
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00132200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant