1134105620 NPI number — IMMEDIATE CARE P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134105620 NPI number — IMMEDIATE CARE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMMEDIATE CARE P.C.
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:
1134105620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
618 NEWARK AVE STE 220
Provider Second Line Business Mailing Address:
JAMA CLAIMS PROCESSING, LLC
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07306-2318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-792-8859
Provider Business Mailing Address Fax Number:
201-792-8869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1856 KENNEDY BLVD
Provider Second Line Business Practice Location Address:
IMMEDIATE CARE P.C.
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07305-2122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-333-7606
Provider Business Practice Location Address Fax Number:
201-333-8789
Provider Enumeration Date:
12/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EL-AMIR
Authorized Official First Name:
MEDHAT
Authorized Official Middle Name:
ELSAYED
Authorized Official Title or Position:
SENIOR PHYSICAN
Authorized Official Telephone Number:
201-792-8859

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6704808 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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