Healthcare Provider Details

I. General information

NPI: 1093123309
Provider Name (Legal Business Name): ICU NJ, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 NW CORPORATE BLVD STE 105
BOCA RATON FL
33431-8554
US

IV. Provider business mailing address

PO BOX 743083
ATLANTA GA
30374-3083
US

V. Phone/Fax

Practice location:
  • Phone: 561-299-3667
  • Fax: 561-299-3670
Mailing address:
  • Phone: 561-299-3667
  • Fax: 561-299-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: PHILIP LUDWIG
Title or Position: OWNER
Credential: MD
Phone: 561-299-3667