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Organization
IRVINGTON FAMILY MEDICINE
Active
Organization
IRVINGTON FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELLONEY JACKSON (PARTNER)
(973) 373-3000
Entity
Organization
Contact information
Practice address
852 18TH AVE, IRVINGTON, NJ 07111-2756
(973) 373-3000
Mailing address
12 KROTIK PL, IRVINGTON, NJ 07111-1708
(973) 373-3000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MA04275
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0887307
—
NJ
Enumeration date
04/02/2010
Last updated
04/02/2010
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