Provider Demographics
NPI:1417185711
Name:INTEGRATED MEDICAL CENTER OF BAYONNE,LLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL CENTER OF BAYONNE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-991-1220
Mailing Address - Street 1:42 QUARRY DR
Mailing Address - Street 2:
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-4201
Mailing Address - Country:US
Mailing Address - Phone:917-991-1220
Mailing Address - Fax:
Practice Address - Street 1:449 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5105
Practice Address - Country:US
Practice Address - Phone:201-823-2334
Practice Address - Fax:201-823-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0033221207R00000X
NJ25MA08448100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty