# CCMMA NJ LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124543095
- **Authorized official:** LAURIE LADUCA (MANAGER)
- **Authorized official phone:** (845) 702-2711

## Contact information

- **Practice address:** 350 BOULEVARD, PASSAIC, NJ 07055-2840
- **Practice address phone:** (973) 365-4300
- **Mailing address:** PO BOX 631800, CINCINNATI, OH 45263-1800
- **Mailing address phone:** (845) 702-2711
- **Mailing address fax:** (888) 220-6560

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LC0200X | Critical Care Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LC0200X | Critical Care Medicine (Anesthesiology) Physician | — | — | Yes |
| 207RC0200X | Critical Care Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RC0200X | Critical Care Medicine (Internal Medicine) Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 08/11/2017
- **Last updated:** 10/14/2022