Provider Demographics
NPI:1639534423
Name:MEDICAL SPECIALIST OF NORTHERN JERSEY LLC
Entity Type:Organization
Organization Name:MEDICAL SPECIALIST OF NORTHERN JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFAKIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-239-6556
Mailing Address - Street 1:189 BERDAN AVE
Mailing Address - Street 2:SUITE 147
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:378 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-1353
Practice Address - Country:US
Practice Address - Phone:973-925-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08660200207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty