Healthcare Provider Details

I. General information

NPI: 1639547375
Provider Name (Legal Business Name): CITY MEDICAL OF NEW JERSEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 WASHINGTON ST
HOBOKEN NJ
07030-4738
US

IV. Provider business mailing address

1345 RXR PLZ
UNIONDALE NY
11556-1301
US

V. Phone/Fax

Practice location:
  • Phone: 201-754-1005
  • Fax: 201-754-1006
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