Organization
NJ MED, PA
Active
Organization
NJ MED, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VIVIAN SHAUGHNESSY (OFFICE MANAGER)
(908) 355-8877
Entity
Organization
Contact information
Practice address
240 WILLIAMSON ST, SUITE 204, ELIZABETH, NJ 07202
(908) 355-8877
(908) 355-0017
Mailing address
240 WILLIAMSON ST, SUITE 204, ELIZABETH, NJ 07202
(908) 355-8877
(908) 355-0017
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2885305
—
NJ
Enumeration date
10/21/2006
Last updated
09/11/2014
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