Sidwa Enterprise II, LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

26NN10119300 Issued in NJ

Legal business name

SIDWA ENTERPRISE II, LLC

Practice address

1043 Montauk Dr
Forked River, NJ 08731-2004

Phone

(609) 339-5667

Fax

(888) 836-3950

NPI assigned

May 4, 2016

Last updated

May 10, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Vickie S Sidwa, ANPNPI 1912088972

Title

President Owner

Phone

(609) 339-5667

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vickie Suzanne Sidwa, APN, C.

  • Adult Health Nurse Practitioner
  • Forked River, NJ
  • NPI 1912088972
  Authorized official Same address or phone

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

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462838400000",
    "number": "1902252315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1043 MONTAUK DR",
            "city": "FORKED RIVER",
            "state": "NJ",
            "postal_code": "087312004",
            "telephone_number": "609-339-5667",
            "fax_number": "888-836-3950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1043 MONTAUK DR",
            "city": "FORKED RIVER",
            "state": "NJ",
            "postal_code": "087312004",
            "telephone_number": "609-339-5667",
            "fax_number": "888-836-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIDWA ENTERPRISE II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-04",
        "last_updated": "2016-05-10",
        "status": "A",
        "authorized_official_last_name": "SIDWA",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT   OWNER",
        "authorized_official_telephone_number": "609-339-5667",
        "authorized_official_credential": "ANP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NJ",
            "license": "26NN10119300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Health Nurse Practitioner in Forked River, NJ
• Providers in Forked River, NJ by specialty
• Adult Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; 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.