Provider Demographics
NPI:1477591360
Name:EMERGENCY MEDICAL ASSOCIATES OF NEW JERSEY PA
Entity Type:Organization
Organization Name:EMERGENCY MEDICAL ASSOCIATES OF NEW JERSEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:IANNACCONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-740-0607
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0717
Mailing Address - Country:US
Mailing Address - Phone:973-740-0607
Mailing Address - Fax:973-740-9895
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:MORRISTOWN MEMORIAL HOSPITAL EMERGENCY DEPARTMENT
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-5007
Practice Address - Fax:973-740-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4059808Medicaid
NJ4059808Medicaid