Provider Demographics
NPI:1144575739
Name:JERSEY IRISH MEDICAL
Entity Type:Organization
Organization Name:JERSEY IRISH MEDICAL
Other - Org Name:AFC URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-469-3627
Mailing Address - Street 1:601 W. UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805
Mailing Address - Country:US
Mailing Address - Phone:732-469-3627
Mailing Address - Fax:732-667-3708
Practice Address - Street 1:601 W. UNION AVE.
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805
Practice Address - Country:US
Practice Address - Phone:732-469-3627
Practice Address - Fax:732-667-3708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09394200207Q00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty