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General NPI Number Information
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NPI Number | 1083910616
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Entity Type | Organization
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Legal Business Name | MEDICAL CENTERS OF NORTHERN NEW JERSEY, LLC
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Dates
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Enumeration Date | 01/29/2011
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Last Update Date | 01/29/2011
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Provider Practice Location Address
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Address Line | 195 S MAPLE AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-5142
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Country | US
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Telephone | 973-953-8105
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Fax | 770-643-2011
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Provider Business Mailing Address
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Address Line | 195 S MAPLE AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-5142
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Country | US
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Telephone | 973-953-8105
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Fax | 770-643-2011
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Authorized Official
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Title or Position | CEO
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Name | MR. DANA PICCIRILLO
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Credential | DC
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Telephone | 678-849-3782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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