Provider Demographics
NPI:1205831468
Name:NEW JERSEY ASSOCIATES IN MEDICINE, PA
Entity Type:Organization
Organization Name:NEW JERSEY ASSOCIATES IN MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:V
Authorized Official - Last Name:CAPPITELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-796-2255
Mailing Address - Street 1:31-00 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3963
Mailing Address - Country:US
Mailing Address - Phone:201-796-2255
Mailing Address - Fax:201-796-3711
Practice Address - Street 1:31-00 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3963
Practice Address - Country:US
Practice Address - Phone:201-796-2255
Practice Address - Fax:201-796-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3419801Medicaid
NJ3419801Medicaid