Provider Demographics
NPI:1114615861
Name:ECJ MEDICAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:ECJ MEDICAL SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDROSO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:305-910-6091
Mailing Address - Street 1:8851 NW 119TH ST UNIT 3206
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7909
Mailing Address - Country:US
Mailing Address - Phone:305-910-6091
Mailing Address - Fax:
Practice Address - Street 1:8851 NW 119TH ST UNIT 3206
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-7909
Practice Address - Country:US
Practice Address - Phone:305-910-6091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty