Healthcare Provider Details

I. General information

NPI: 1568858686
Provider Name (Legal Business Name): CITY MEDICAL OF NEW JERSEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 E RTE 4
PARAMUS NJ
07652-5101
US

IV. Provider business mailing address

1345 RXR PLZ
UNIONDALE NY
11556-1301
US

V. Phone/Fax

Practice location:
  • Phone: 551-222-0800
  • Fax: 551-222-0801
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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. RICHARD PARK
Title or Position: MANAGING OWNER
Credential: MD
Phone: 516-783-4600