Provider Demographics
NPI:1558763128
Name:MY MD URGENT CARE PROFESSIONAL ASSN
Entity Type:Organization
Organization Name:MY MD URGENT CARE PROFESSIONAL ASSN
Other - Org Name:MY MD URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZZIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-821-2518
Mailing Address - Street 1:332 E RTE 4
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:332 E RTE 4
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5114
Practice Address - Country:US
Practice Address - Phone:917-821-2518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care