Provider Demographics
NPI:1396021374
Name:MEDIJN ASSOCIATES
Entity Type:Organization
Organization Name:MEDIJN ASSOCIATES
Other - Org Name:REMEDI MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:609-850-1989
Mailing Address - Street 1:PO BOX 1873
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-7473
Mailing Address - Country:US
Mailing Address - Phone:609-850-1989
Mailing Address - Fax:
Practice Address - Street 1:73 JENNIFER LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-1145
Practice Address - Country:US
Practice Address - Phone:609-850-1989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0600377600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty