New Balance Occupational Medicine, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NEW BALANCE OCCUPATIONAL MEDICINE, LLC

Practice address

1574 E 85TH Ave
Merrillville, IN 46410

Phone

(219) 769-4400

Fax

(219) 795-1419

NPI assigned

Feb 18, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Oranu G Ibekie

Title

MD

Phone

(219) 769-4400

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556064000000",
    "number": "1184921652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10746",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464110746",
            "telephone_number": "219-769-4400",
            "fax_number": "219-795-1419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1574 E 85TH AVE",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "46410",
            "telephone_number": "219-769-4400",
            "fax_number": "219-795-1419"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1574 E 85th Ave",
            "address_purpose": "LOCATION",
            "city": "Merrillville",
            "state": "IN",
            "postal_code": "46410",
            "country_code": "US",
            "telephone_number": "219-769-4400",
            "fax_number": "219-795-1419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NEW BALANCE OCCUPATIONAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-18",
        "last_updated": "2019-04-24",
        "status": "A",
        "authorized_official_last_name": "IBEKIE",
        "authorized_official_first_name": "ORANU",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "219-769-4400"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "IN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201016650A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Merrillville, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.