Provider Demographics
NPI:1417021841
Name:UNION MEDICAL, LLC
Entity Type:Organization
Organization Name:UNION MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-851-2666
Mailing Address - Street 1:2182 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5902
Mailing Address - Country:US
Mailing Address - Phone:908-851-2666
Mailing Address - Fax:908-851-2299
Practice Address - Street 1:2182 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5902
Practice Address - Country:US
Practice Address - Phone:908-851-2666
Practice Address - Fax:908-851-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2007-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00493100111N00000X
NJ25MA07067900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ024775OtherGROUP ID #