Provider Demographics
NPI:1467117689
Name:RELIANT.MD MEDICAL ASSOCIATES OF NEW JERSEY L.L.C
Entity Type:Organization
Organization Name:RELIANT.MD MEDICAL ASSOCIATES OF NEW JERSEY L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-204-5109
Mailing Address - Street 1:6500 RIVERPLACE BUILDING 4 SUITE 102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730
Mailing Address - Country:US
Mailing Address - Phone:855-632-6940
Mailing Address - Fax:469-340-0657
Practice Address - Street 1:6500 RIVERPLACE BUILDING 4 SUITE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730
Practice Address - Country:US
Practice Address - Phone:855-632-6940
Practice Address - Fax:469-340-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty