Healthcare Provider Details

I. General information

NPI: 1548343973
Provider Name (Legal Business Name): NJ MED, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLIAMSON ST SUITE 204
ELIZABETH NJ
07202
US

IV. Provider business mailing address

240 WILLIAMSON ST SUITE 204
ELIZABETH NJ
07202
US

V. Phone/Fax

Practice location:
  • Phone: 908-355-8877
  • Fax: 908-355-0017
Mailing address:
  • Phone: 908-355-8877
  • Fax: 908-355-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. VIVIAN SHAUGHNESSY
Title or Position: OFFICE MANAGER
Credential:
Phone: 908-355-8877