Provider Demographics
NPI:1619427028
Name:INTENSIVE CARE MEDICINE MANAGEMENT ASSOCIATES LLC
Entity Type:Organization
Organization Name:INTENSIVE CARE MEDICINE MANAGEMENT ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMHARACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-282-9385
Mailing Address - Street 1:P.O. BOX 1094
Mailing Address - Street 2:OLD CHELSEA STATION
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1091
Mailing Address - Country:US
Mailing Address - Phone:917-282-9385
Mailing Address - Fax:
Practice Address - Street 1:350 BOULEVARD
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2840
Practice Address - Country:US
Practice Address - Phone:917-282-9385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty