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Organization
INFECTIOUS DISEASES SERVICES OF NEW JERSEY LLC
Active
Organization
INFECTIOUS DISEASES SERVICES OF NEW JERSEY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKHAIL MOURAVSKI (PRACTICE MANAGER)
(973) 953-6673
Entity
Organization
Contact information
Practice address
511 S ORANGE AVE, SOUTH ORANGE, NJ 07079-2636
(973) 200-3600
(973) 821-3651
Mailing address
511 S ORANGE AVE, SOUTH ORANGE, NJ 07079-2636
(973) 200-3600
(973) 821-3651
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RI0200X
Infectious Disease Physician
Primary
—
NULL
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Enumeration date
06/22/2010
Last updated
06/22/2010
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