Provider Demographics
NPI:1275240954
Name:PROSPERO MEDICAL SERVICES NEW JERSEY PC
Entity Type:Organization
Organization Name:PROSPERO MEDICAL SERVICES NEW JERSEY PC
Other - Org Name:LANDMARK MEDICAL OF NEW JERSEY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF MEDICAL GROUP
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-237-2450
Mailing Address - Street 1:7755 CENTER AVE STE 630
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-9152
Mailing Address - Country:US
Mailing Address - Phone:657-400-5180
Mailing Address - Fax:
Practice Address - Street 1:1 GATEWAY CTR STE 2600
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-5323
Practice Address - Country:US
Practice Address - Phone:657-400-5180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty