Provider Demographics
NPI:1306500350
Name:ONIMUS, JUSTINA
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:ONIMUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 S DELSEA DRIVE
Mailing Address - Street 2:STE 3
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-0742
Mailing Address - Country:US
Mailing Address - Phone:856-794-1003
Mailing Address - Fax:856-794-9178
Practice Address - Street 1:2848 S DELSEA DRIVE
Practice Address - Street 2:STE 3
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-0742
Practice Address - Country:US
Practice Address - Phone:856-794-1003
Practice Address - Fax:856-794-9178
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01221700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily