Provider Demographics
NPI:1225257330
Name:PHOTOPHERESIS OF NEW JERSEY
Entity Type:Organization
Organization Name:PHOTOPHERESIS OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BISACCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-292-1358
Mailing Address - Street 1:182 SOUTH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5377
Mailing Address - Country:US
Mailing Address - Phone:973-292-1358
Mailing Address - Fax:973-695-1369
Practice Address - Street 1:182 SOUTH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5377
Practice Address - Country:US
Practice Address - Phone:973-292-1358
Practice Address - Fax:973-695-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ158348Medicare ID - Type UnspecifiedMEDICARE ID