Provider Demographics
NPI:1720014830
Name:OLD HOOK MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:OLD HOOK MEDICAL ASSOCIATES, LLC
Other - Org Name:OLD HOOK MEDICAL ASSOCIATES SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING/CREDENTIALING
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:LIJO
Authorized Official - Suffix:
Authorized Official - Credentials:CCS-P
Authorized Official - Phone:201-666-3900
Mailing Address - Street 1:452 OLD HOOK RD
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1381
Mailing Address - Country:US
Mailing Address - Phone:201-666-3900
Mailing Address - Fax:201-261-0505
Practice Address - Street 1:452 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1381
Practice Address - Country:US
Practice Address - Phone:201-666-3900
Practice Address - Fax:201-261-0505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLD HOOK MEDICAL ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-23
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1092980261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072605Medicare PIN
NJ000991Medicare PIN