1003071143 NPI number — JERSEY CITY CRITICAL CARE ASSOCIATES

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 1003071143 NPI number — JERSEY CITY CRITICAL CARE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERSEY CITY CRITICAL CARE ASSOCIATES
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:
1003071143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THREE BRIDGES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08887-0011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-806-8224
Provider Business Mailing Address Fax Number:
908-788-3084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 GRAND ST
Provider Second Line Business Practice Location Address:
JERSEY CITY MEDICAL CENTER
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07302-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-806-8224
Provider Business Practice Location Address Fax Number:
908-788-3084
Provider Enumeration Date:
07/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MESSINA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PROPRIETOR
Authorized Official Telephone Number:
908-806-8224

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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