Provider Demographics
NPI:1235365354
Name:MM JC BREATHING CENTER FAMILY LTD PARTNERSHIP
Entity Type:Organization
Organization Name:MM JC BREATHING CENTER FAMILY LTD PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAZHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAMIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-333-5363
Mailing Address - Street 1:192 HARRISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1906
Mailing Address - Country:US
Mailing Address - Phone:201-333-5363
Mailing Address - Fax:201-333-4710
Practice Address - Street 1:192 HARRISON AVENUE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1906
Practice Address - Country:US
Practice Address - Phone:201-333-5363
Practice Address - Fax:201-333-4710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MM JERSEY CITY BREATHING CENTER FAMILY LTD PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-03
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04785700207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1265008Medicaid
NJ1265008Medicaid
NJ450946Medicare PIN