Provider Demographics
NPI:1972728327
Name:COLMEXI MEDICAL, LLC
Entity type:Organization
Organization Name:COLMEXI MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:SABIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-866-8533
Mailing Address - Street 1:1085 FRANKLIN LAKES ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1131
Mailing Address - Country:US
Mailing Address - Phone:201-866-8533
Mailing Address - Fax:201-866-6994
Practice Address - Street 1:805 11TH STREET
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6203
Practice Address - Country:US
Practice Address - Phone:201-866-8533
Practice Address - Fax:201-866-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07696900174400000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0121070Medicaid
NJ111487Medicare PIN