MEDICARE: MEDASSIST NJ II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1336928407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDASSIST NJ II

Provider Business Mailing Address
First Line	:	419 E COUNTY LINE RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 E COUNTY LINE RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1426
Country	:	US
Telephone Number	:	917-882-4536
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	YEHDUA SCHNEIDER
Credential	:
Telephone Number	:	917-882-4536

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	09/27/2023

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