Organization
EVERGREEN PHYSICIANS OF NORTH JERSEY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY KONDAS (OFFICER)
(973) 251-1132
Entity
Organization
Contact information
Practice address
96 PARKWAY, EVERGREEN PHYSICIANS OF NORTH JERSEY, PC, ROCHELLE PARK, NJ 07662-4200
(973) 450-2540
(919) 425-0478
Mailing address
3114 CROASDAILE DR STE 200, EVERGREEN PHYSICIANS OF NORTH JERSEY, PC, DURHAM, NC 27705-2508
(954) 838-2371
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MB06960500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0102091
—
NJ
Enumeration date
05/06/2006
Last updated
12/22/2020
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