Healthcare Provider Details

I. General information

NPI: 1952842460
Provider Name (Legal Business Name): PHYSICIAN SPECIALISTS OF NORTHERN JERSEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SEARS DR STE 306
PARAMUS NJ
07652-3510
US

IV. Provider business mailing address

1 SEARS DR SUITE 306
PARAMUS NJ
07652-3515
US

V. Phone/Fax

Practice location:
  • Phone: 201-830-2287
  • Fax: 201-830-2286
Mailing address:
  • Phone: 201-830-2287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL L GROSS
Title or Position: OWNER/PARTNER
Credential: MD
Phone: 201-830-2287