Provider Demographics
NPI:1043362940
Name:NORTH JERSEY INFECTIOUS DISEASE GROUP LLC
Entity Type:Organization
Organization Name:NORTH JERSEY INFECTIOUS DISEASE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIHRAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEFERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-503-0660
Mailing Address - Street 1:200 GRAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4371
Mailing Address - Country:US
Mailing Address - Phone:201-503-0660
Mailing Address - Fax:201-503-0685
Practice Address - Street 1:200 GRAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4371
Practice Address - Country:US
Practice Address - Phone:201-503-0660
Practice Address - Fax:201-503-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62848207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ124108Medicare PIN