1629371810 NPI number — NEW JERSEY MEDICAL SERVICES, PC

Table of content: (NPI 1629371810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629371810 NPI number — NEW JERSEY MEDICAL SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW JERSEY MEDICAL SERVICES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629371810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 HIGHVIEW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOSTER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07624-2820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 BERGENLINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07087-3917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
551-574-7018
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KATZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
551-574-7018

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 25MA06519400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)