Provider Demographics
NPI:1134315302
Name:NEW JERSEY INFECTIOUS DISEASE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:NEW JERSEY INFECTIOUS DISEASE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:VASILIOS
Authorized Official - Middle Name:N
Authorized Official - Last Name:VELMAHOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-906-1900
Mailing Address - Street 1:113 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3946
Mailing Address - Country:US
Mailing Address - Phone:732-906-1900
Mailing Address - Fax:732-906-6666
Practice Address - Street 1:113 JAMES ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3946
Practice Address - Country:US
Practice Address - Phone:732-906-1900
Practice Address - Fax:732-906-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7448406Medicaid
NJ003933Medicare PIN