Provider Demographics
NPI:1518557750
Name:THE MEDISTATION LLC
Entity Type:Organization
Organization Name:THE MEDISTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRONZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-799-7400
Mailing Address - Street 1:634 EAGLE ROCK AVE UNIT 503
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-6812
Mailing Address - Country:US
Mailing Address - Phone:862-799-7400
Mailing Address - Fax:
Practice Address - Street 1:57 E MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3003
Practice Address - Country:US
Practice Address - Phone:862-799-7400
Practice Address - Fax:973-345-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty