Healthcare Provider Details

I. General information

NPI: 1922148667
Provider Name (Legal Business Name): AURORA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 OVERLOOK AVE SUITE 2
HACKENSACK NJ
07601-2205
US

IV. Provider business mailing address

130 OVERLOOK AVE SUITE 2
HACKENSACK NJ
07601-2205
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-4008
  • Fax: 201-342-4228
Mailing address:
  • Phone: 201-342-4008
  • Fax: 201-342-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA62482
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierHEALTHNET
Identifier TypeOTHER
Identifier State
Identifier Issuer2K2256
# 2
IdentifierOXFORD
Identifier TypeOTHER
Identifier State
Identifier IssuerP880048
# 3
IdentifierEMPIRE
Identifier TypeOTHER
Identifier State
Identifier Issuer53S971

VIII. Authorized Official

Name: AURORA C ANDREESCU
Title or Position: OWNER
Credential: MD
Phone: 201-342-4008