MEDICARE: FIRSTMED OF NJ LLC

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	207R00000X	Internal Medicine Physician	25MA08823600	NJ
2	261QU0200X	Urgent Care Clinic/Center	25MA08823600	NJ

General Provider Information

NPI Number	:	1770832024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRSTMED OF NJ LLC

Provider Business Mailing Address
First Line	:	1640 SCHLOSSER STREET
Second Line	:	SUITE C-3
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5655
Country	:	US
Telephone Number	:	201-957-6012
Fax Number	:	201-944-4006

Provider Business Practice Location Address
First Line	:	1640 SCHLOSSER ST
Second Line	:	SUITE C-3
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5606
Country	:	US
Telephone Number	:	201-957-6012
Fax Number	:	201-944-4006

Authorized Official
Title or Position	:	M.D.
Name	:	DR. STEVEN N KIM
Credential	:
Telephone Number	:	201-957-6012

Provider Enumeration Date	:	08/31/2012
Last Update Date	:	11/20/2012

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Directions to “FIRSTMED OF NJ LLC ” Practice Location

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