Provider Demographics
NPI:1033232558
Name:JERSEY MEDICAL CARE,PC
Entity Type:Organization
Organization Name:JERSEY MEDICAL CARE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GORYUNOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-679-4500
Mailing Address - Street 1:3895 RT.516
Mailing Address - Street 2:STE 2B
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857
Mailing Address - Country:US
Mailing Address - Phone:732-679-4500
Mailing Address - Fax:732-679-4549
Practice Address - Street 1:3895 RT.516
Practice Address - Street 2:STE 2B
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857
Practice Address - Country:US
Practice Address - Phone:732-679-4500
Practice Address - Fax:732-679-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081798Medicare PIN