Healthcare Provider Details

I. General information

NPI: 1568394765
Provider Name (Legal Business Name): 360 NEW JERSEY MEDICAL GROUP PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 E JERSEY ST
ELIZABETH NJ
07201-2473
US

IV. Provider business mailing address

971 US HIGHWAY 202 N STE N
BRANCHBURG NJ
08876-3757
US

V. Phone/Fax

Practice location:
  • Phone: 551-372-9260
  • Fax:
Mailing address:
  • Phone: 551-372-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES VILLAR
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-645-1192