Provider Demographics
NPI:1568588671
Name:JERSEY MEDICAL SPECIALISTS INC
Entity Type:Organization
Organization Name:JERSEY MEDICAL SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-607-2447
Mailing Address - Street 1:10 CINDY ST
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3002
Mailing Address - Country:US
Mailing Address - Phone:732-607-2447
Mailing Address - Fax:732-607-2449
Practice Address - Street 1:10 CINDY ST
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3002
Practice Address - Country:US
Practice Address - Phone:732-607-2447
Practice Address - Fax:732-607-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010825Medicare PIN