Provider Demographics
NPI:1619125580
Name:CEDAR MEDICAL
Entity Type:Organization
Organization Name:CEDAR MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:POLIMENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-928-0101
Mailing Address - Street 1:222 CEDAR LN STE 201
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4312
Mailing Address - Country:US
Mailing Address - Phone:201-928-0101
Mailing Address - Fax:201-928-0505
Practice Address - Street 1:222 CEDAR LN STE 201
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4312
Practice Address - Country:US
Practice Address - Phone:201-928-0101
Practice Address - Fax:201-928-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05504100261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
E53383Medicare UPIN
P05227Medicare UPIN
P18679Medicare UPIN