Provider Demographics
NPI:1235582107
Name:NORTH JERSEY LAPAROSCOPIC ASSOCIATES
Entity Type:Organization
Organization Name:NORTH JERSEY LAPAROSCOPIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAIMAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-530-1900
Mailing Address - Street 1:222 CEDAR LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4314
Mailing Address - Country:US
Mailing Address - Phone:201-530-1900
Mailing Address - Fax:201-530-9300
Practice Address - Street 1:222 CEDAR LN
Practice Address - Street 2:SUITE 201
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4314
Practice Address - Country:US
Practice Address - Phone:201-530-1900
Practice Address - Fax:201-530-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07456100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ073995Medicare UPIN