Provider Demographics
NPI:1174768048
Name:OBARA, JUSTYNA
Entity type:Individual
Prefix:DR
First Name:JUSTYNA
Middle Name:
Last Name:OBARA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JUSTYNA
Other - Middle Name:
Other - Last Name:ADAMCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:785 W SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6913
Mailing Address - Country:US
Mailing Address - Phone:856-451-4700
Mailing Address - Fax:
Practice Address - Street 1:785 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6913
Practice Address - Country:US
Practice Address - Phone:856-451-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08551400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ197272WH9Medicare PIN