Provider Demographics
NPI:1003581042
Name:COMMUNITY HEALTH GROUP LLC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FREDDY
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-782-5550
Mailing Address - Street 1:540 STRAIGHT ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-3240
Mailing Address - Country:US
Mailing Address - Phone:862-657-5500
Mailing Address - Fax:862-657-5501
Practice Address - Street 1:540 STRAIGHT ST STE 2C
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-3240
Practice Address - Country:US
Practice Address - Phone:862-657-5500
Practice Address - Fax:862-657-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1780957530OtherINTERNAL MEDICINE