Provider Demographics
NPI:1275865461
Name:JEFFREY B DANZIG MD PC
Entity Type:Organization
Organization Name:JEFFREY B DANZIG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DANZIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-445-8787
Mailing Address - Street 1:2 WINTHROP DR
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7856
Mailing Address - Country:US
Mailing Address - Phone:201-445-8787
Mailing Address - Fax:201-445-8556
Practice Address - Street 1:127 UNION ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4478
Practice Address - Country:US
Practice Address - Phone:201-445-8787
Practice Address - Fax:201-445-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA54828207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0479101Medicaid
NY01036584Medicaid
NY01036584Medicaid