Provider Demographics
NPI:1699859249
Name:DAUGHTERS OF MIRIAM CTR PHYSICIAN GROUP
Entity Type:Organization
Organization Name:DAUGHTERS OF MIRIAM CTR PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:DASILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-253-5210
Mailing Address - Street 1:155 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3423
Mailing Address - Country:US
Mailing Address - Phone:973-253-5210
Mailing Address - Fax:973-772-8243
Practice Address - Street 1:155 HAZEL ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3423
Practice Address - Country:US
Practice Address - Phone:973-253-5210
Practice Address - Fax:973-772-8243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7063202Medicaid
NJ7063202Medicaid