Healthcare Provider Details

I. General information

NPI: 1225621717
Provider Name (Legal Business Name): JERSEY CITY MEDICAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JOURNAL SQ STE 915
JERSEY CITY NJ
07306-4007
US

IV. Provider business mailing address

35 JOURNAL SQ STE 915
JERSEY CITY NJ
07306-4007
US

V. Phone/Fax

Practice location:
  • Phone: 914-376-6100
  • Fax: 914-470-5056
Mailing address:
  • Phone: 914-376-6100
  • Fax: 914-470-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: INNA LEVETSENKO
Title or Position: OWNER
Credential:
Phone: 914-376-6100