Healthcare Provider Details

I. General information

NPI: 1417325986
Provider Name (Legal Business Name): CITY MEDICAL OF NEW JERSEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 ROUTE 3
CLIFTON NJ
07012-2343
US

IV. Provider business mailing address

1345 RXR PLZ
UNIONDALE NY
11556-1301
US

V. Phone/Fax

Practice location:
  • Phone: 973-450-1991
  • Fax:
Mailing address:
  • Phone: 516-783-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARLENA SIMPSON
Title or Position: VP, CREDENTIALING
Credential: CPMSM
Phone: 516-453-0435