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General NPI Number Information
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NPI Number | 1962575167
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Entity Type | Organization
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Legal Business Name | VITAMED FAMILY PRACTICE
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 3000 KENNEDY BLVD SUITE 308
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City | JERSEY CITY
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State | NJ
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Zip | 07306
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Country | US
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Telephone | 201-963-0800
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Fax | 201-656-6934
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Provider Business Mailing Address
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Address Line | 3000 KENNEDY BLVD SUITE 308
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City | JERSEY CITY
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State | NJ
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Zip | 07306
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Country | US
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Telephone | 201-963-0800
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Fax | 201-656-6934
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Authorized Official
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Title or Position | PRESIDENT
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Name | TADEUSZ JANUSZ MAJCHRZAK
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Credential | MD
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Telephone | 201-963-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | MA5867500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | MA5867500
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License Number State | NJ
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